Chatham-Kent Board of Health Agenda Wednesday, February 19, 2020 11:00 A.M.
Health and Family Services Building Room 301, 435 Grand Avenue West Chatham, ON
To Attend:
Mr. Brennan Altiman Ms. Noreen Blake Mr. Ron Carnahan Councillor Joe Faas (Chair) Councillor Karen Kirkwood-Whyte Councillor Brock McGregor (Vice Chair) Councillor Carmen McGregor Ms. Sharon Pfaff Teresa Bendo, Director, Public Health Dr. David Colby, Medical Officer of Health Dr. April Rietdyk, General Manager, Community Human Services Lisa Powers, Executive Assistant, Community Human Services
1. Call of the Roll
2. Disclosures of Pecuniary Interest (Direct or Indirect) and the General Nature Thereof
3. Minutes of the Board Meeting of January 15, 2020, page 301
4. Education and Training
a) Update on Novel Coronavirus (2019-nCoV), presentation by Dr. David Colby, Medical Officer of Health
5. Business Arising From the Minutes - None
6. New Business
A. Items Requiring Action
a) Monitoring Food Affordability, page 501 b) CK Food Policy Council Minutes, March 13, 2019, page 507 Page 2 of 2 Chatham-Kent Board of Health Agenda Wednesday, February 19, 2020 11:00 A.M.
B. Information Reports to be Received
a) Director’s Report for the Month of February, 2020, verbal report b) CK Public Health – Health Stats Portal, page 701 C. Items to be Received and Filed
a) Association of Local Public Health Agencies (alPHa) Information Break, dated February 3, 2020, page 901 b) Letter from Peterborough Public Health to Ministers Mulroney and Elliott regarding Off Road Vehicles and Bills 107 and 132, page 905 c) alPHa response on Public Health Modernization, page 909 d) alPHa 2020 AGM package, page 939 e) Resolution from Windsor-Essex County Health Unit regarding Healthy Smiles Ontario Funding, page 949
7. Non-Agenda Items
8. Time, Date and Place for the Next Regular Meeting of the Board:
Wednesday, March 18, 2020 11:00 a.m., Rm. 301, Health and Family Services Building, 435 Grand Ave. W., Chatham.
9. Adjournment 301
Chatham-Kent Board of Health Minutes Wednesday, January 15, 2020 11:00 a.m.
Call to Order Present: Councillor Joe Faas (Chair) Councillor Karen Kirkwood-Whyte Councillor Brock McGregor (Vice-Chair) Councillor Carmen McGregor Ms. Noreen Blake Mr. Ron Carnahan Teresa Bendo, Director, Public Health Dr. David Colby, Medical Officer of Health Dr. April Rietdyk, General Manager, Community Human Services Lisa Powers, Executive Assistant, Community Human Services
Regrets: Ms. Sharon Pfaff
Absent: Mr. Brennan Altiman
Guests: Rachel Guerin, Blenheim Youth Centre (BYC); Pauline Nash, AIDS Committee Windsor; Emily Robert, BYC; Krystal Guyitt, Hope Haven; Councillor Clare Latimer; Jason Stubitz, CK Local Immigration Partnership; Hope Mugridge, St. Andrews Residence; Beth Kominek, Chatham-Kent Community Health Centre (CKCHC); Laura MacDougald, CKCHC; Alan McGuigan, ROCK Missions; Tania Sharpe, Chatham-Kent Public Library; Gabriel Clarke, Municipality of Chatham-Kent (MOCK); Rebecca Smyth, Access Open Minds; Thomas Kelley, MOCK; Heather Hughes, Lambton-Kent District School Board; Steve Pratt, United Way; Jay Cunningham, Kent Federation of Agriculture; Councillor Marjorie Crew, Family Services Kent (FSK); Brad David, FSK; Rashoo Brar, Chatham-Kent Health Alliance; Wanda Bell, Hope Haven; Kristen Williams, MOCK; Chantal Perry, MOCK; Mark Reinhart, MOCK; Amy Wadsworth, CK YMCA; Rodney Hetherington, Paramedic Services; Donna Litwin-Makey, Children’s Treatment Centre
1. Provision for Declaration of Pecuniary Interest
No member of the Board declared a pecuniary interest on any matter on the open session agenda.
2. Minutes of the Board Meeting of December 18, 2019
Councillor C. McGregor moved, seconded by Mr. Carnahan:
“That the minutes of the December 18, 2019 Board of Health meeting be approved.” 302 Chatham-Kent Board of Health Minutes Page 2 of 3 January 15, 2020
The Chair put the Motion.
Motion Carried
3. Business Arising from the Minutes - None
4. Education/Training
a) Public Health Modernization, Presentation by Teresa Bendo, Director, Public Health In an effort to inform the group on upcoming plans for public health modernization, Ms. Bendo shared a brief PowerPoint presentation. Attendees then participated in a small group exercise aimed at soliciting feedback to inform the Health Unit’s formal consultation response. Councillor C. McGregor moved, seconded by Ms. Blake:
“That the information gathered at the Public Health Modernization Consultation meeting be compiled and submitted by administration to the provincial government by February 10th.”
The Chair put the Motion.
Motion Carried
5. New Business
A. Items Requiring Action - None
B. Information Reports to be received - None
C. Items to be Received and Filed - None
6. Non-Agenda Items - None
7. Time, Date and Place for the Next Meeting of the Board
The next meeting of the Board will be held Wednesday February 19, 2020, at the Health and Family Services building, 435 Grand Ave. W., Chatham, with the open portion of the meeting to start at 11:00 a.m. 303
Chatham-Kent Board of Health Minutes Page 3 of 3 January 15, 2020
8. Adjournment
Moved by Councillor C. McGregor that the meeting be adjourned at 12:00 pm.
Joe Faas, Chair 304 501
Municipality Of Chatham-Kent
Community Human Services
Public Health Unit
To: Board of Health
From: Lyndsay Davidson, RD Public Health Dietitian
Date: February 3, 2020
Subject: Monitoring Food Affordability - 2019
Recommendations
It is recommended that:
1. The Government of Canada be called upon to:
a. Update the list of foods included in the National Nutritious Food Basket to reflect the recommendations from the 2019 Canada’s Food Guide;
b. Develop a national food costing protocol to standardize the annual monitoring of food affordability by provincial/territorial and local governments; and
c. Mandate the annual measurement of food insecurity using the Household Food Security Survey Module.
Background
Consistent monitoring of food affordability and food insecurity is necessary to asses the health of the population, to evaluate policy change, and to develop evidence based recommendations for public health interventions.
This year will mark the twentieth year that Chatham-Kent Public Health has completed a survey of area grocery stores to determine the cost of feeding a family of four for one week.
The Nutritious Food Basket contains 67 items that together form a nutritious diet. Items in the list were aligned with the previous four food groups from Eating Well with Canada’s Food Guide. There are a number of assumptions that are made including that individuals have the time, ability, food skills, literacy, and language skills to prepare meals from scratch, that consumers have access to stores, always purchase the lowest priced items, and that they shop every one to two weeks. 502
Monitoring Food Affordability-2019 Page 2 of 5
The results of the Nutritious Food Basket are used provincially to help advocate for changes to public policy that will work to ensure that all citizens have access to an adequate income to support basic needs, including healthy food.
Comments
The cost of the Chatham-Kent Nutritious Food Basket in 2019 was $203.59; in 2018 it was $193.31. This amount is based on average costs of feeding a family of four for one week. Food costs were obtained from six different grocery stores across Chatham-Kent in both urban and rural settings. This year, the average weekly cost for a family of four has increased by 5.05%. Other communities across Ontario also noted that there was a large increase in the cost for 2019, with some over 10%.
The Food Insecurity Workgroup of the Ontario Dietitians in Public Health (ODPH) has created an Income Scenario Tool to help put the Nutritious Food Basket results into a realistic context of costs for individuals and families. The following table outlines scenarios including housing costs specific to Chatham-Kent, as well as food costs obtained from the 2019 Nutritious Food Basket for Chatham-Kent.
Monthly Single Man Single Man Family of 4 Family of 4 Family of 4 Income/Expenses (Ontario (ODSP) Ontario Minimum Medium Income Works) Works Wage Earner (after tax) Income – after tax, $825.00 $1,272.00 $2,623.00 $3,633.00 $7,983.00 includes Benefits & Credits Estimated Shelter $579.00 $705.00 $1,010.06 $1,010.06 $1,010.06 Costs *Bachelor *1 Bedroom Food (Nutritious $296.22 $296.22 $881.54 $881.54 $881.54 Food Basket) What’s Left? -$50.22 $270.78 $731.40 $1741.40 $6091.4
% Income required 70% 55% 39% 28% 13% for Shelter % Income required 36% 23% 34% 24% 11% for Food People still need funds for utilities, phone, transportation, cleaning supplies, personal care items, clothing, gifts, entertainment, internet, school supplies, medical and dental costs, and other costs.
Overall, the above chart demonstrates that there are significant financial pressures on families and individuals living on low incomes in Chatham-Kent. Those living on low incomes have little, if any, money left over to cover basic monthly expenses after paying for food and shelter. In general, food in Chatham-Kent is affordable for residents with adequate incomes. For example, a family of four with a median income spends only 11% of their after tax income on food. Households with low incomes spend up to 39% of their income on food, not because food costs too much, but because their incomes are too low.
Household food insecurity – the inadequate or insecure access to food due to financial constraints – is a serious public health problem in Canadai. Food insecurity is 503
Monitoring Food Affordability-2019 Page 3 of 5
associated with poorer nutritional intakeii. Those experiencing food insecurity often report suboptimal health, multiple chronic conditions, and depression. These individuals also note that food insecurity impacts their ability to perform activities at home, work, or school due to their health statusiii. There are different levels of food insecurity. Marginal food insecurity is worrying about running out of food and/or limited food selection due to a lack of money for food; moderate food insecurity is compromising quality and/or quantity of food due to a lack of money for food; while severe food insecurity is missing meals, reducing food intake, and going day(s) without foodivv.
In May 2019, the food component of the Consumer Price Index (CPI) in Ontario, of foods purchased in stores, increased by 5.2%, when compared to May 2018vi. For most of Ontario, the cause of household food insecurity is not because food prices are too high, but because people with low incomes do not have enough income to cover the costs of basic living, including nutritious foods. An exception would be in northern and remote areas of Ontario, where the high cost of food, along with income, does contribute to food insecurity.
In 2019, the Government of Canada released the new Canada’s Food Guide and Canada’s Dietary Guidelines. This updated version is very different from the previous format of food groups, serving sizes, and recommended daily intakes. Instead, there is a focus on proportion – how much to have of any one kind of food in relation to others - using a plate as a guide. This new approach is meant to make the Guide more useful to average Canadians, who have struggled in the past to meet minimum requirements and follow prescriptive directions.vii Those previous requirements and directions, were the inputs that the food costing and affordability models have been based. The revamp of Canada’s Food Guide will require the tools that we currently use to determine food affordability be updated to reflect the new Food Guide. This process will need significant support to be developed as in the past it was based on the Market Basket Measure and adapted by Ministry of Health and Long Term Care staff to be used by staff in Public Health.
Monitoring of food affordability and insecurity is important to understand the local context and needs. The Population Health Assessment and Surveillance Protocol (2018) includes a requirement to monitor food affordability at a local level as part of population health surveillance data needed to help inform public health practice, programs and services. Further guidance is provided in the Monitoring Food Affordability Reference Document (2018), including some minimum costing requirements and key principals. The Reference Document lists examples of exiting food costing tools that may be used, including Ontario’s Nutritious Food Basket (NFB). The NFB Protocol (2014) and NFB Guidance Document (2010) are outdated and required revision to align with the new Canada’s Food Guide. Whether the NFB or another costing tool is used, public health dietitians require an updated standardized provincial food costing tool that is reliable and valid to lead the consistent collection, interpretation and sharing of local and regional data for monitoring food affordability. At this time, there isn’t a standard tool that is used across Canada to measure food affordability. 504
Monitoring Food Affordability-2019 Page 4 of 5
Additionally, the monitoring of food affordability and accessibly is not federally mandated. The Household Food Security Survey Module (HFSSM) is part of the Canadian Community Health Survey (CCHS), unfortunately it is not always a compulsory module. The decision to collect this data is up to individual provinces and territories and in 2015-16, Ontario chose to not collect HFSSM data. It is important that we seek to ensure that accurate reporting of uniform, nationwide indicators of food affordability and food insecurity. This would facilitate detailed analysis of trends and evaluation of the impact of income-related and other social policy changes, including any adjustments to social assistance rates made by the Ontario government.viii
Areas of Strategic Focus and Critical Success Factors
The recommendations in this report support the following areas of strategic focus:
Economic Prosperity: Chatham-Kent is an innovative and thriving community with a diversified economy
A Healthy and Safe Community: Chatham-Kent is a healthy and safe community with sustainable population growth
People and Culture: Chatham-Kent is recognized as a culturally vibrant, dynamic, and creative community
Environmental Sustainability: Chatham-Kent is a community that is environmentally sustainable and promotes stewardship of our natural resources
The recommendations in this report support the following critical success factors:
Financial Sustainability: The Corporation of the Municipality of Chatham-Kent is financially sustainable
Open, Transparent and Effective Governance: The Corporation of the Municipality of Chatham-Kent is open, transparent and effectively governed with efficient and bold, visionary leadership Has the potential to support all areas of strategic focus & critical success factors ~ Neutral issues (does not support negatively or positively)
Consultation
The results from the Nutritious Food Basket will be shared with the Chatham-Kent community through an updated section on the revamped website, and through 505
Monitoring Food Affordability-2019 Page 5 of 5
agencies/groups such as the Chatham-Kent Food Policy Council, Food Link Chatham- Kent, Building Healthy Babies and the Chatham-Kent Prosperity Roundtable. Public Health Dietitians will utilize the information to aid with program development and future evaluation, as well as supporting our local food charity organizations as requested. It will also be incorporated into various programs including our foods skills program and the Healthy Eating on a Budget Workshop.
Financial Implications
There are no financial impacts to the health unit budget as a result of Monitoring Food Affordability and the Nutritious Food Basket.
Prepared by: Reviewed by:
______Lyndsay Davidson, RD, BASc Chris Sherman, OCT, BHK, B.Ed Public Health Dietitian Program Manager
Reviewed by: Reviewed by:
______Teresa Bendo MBA David Colby, MSc., MD, FRCP (C) Director, Public Health Medical Officer of Health
Reviewed by:
______April Rietdyk, RN, BScN, MHS, PhD PUBH General Manager Community Human Services
Attachments: None
i Vozoris NT, Tarasuk V. Household food insufficiency is associated with poorer health. Journal of Nutrition 2003; 133 (1): 120-6. 506
Monitoring Food Affordability-2019 Page 6 of 5
ii Kirkpatrick SI, Dodd KW, Parsons R, Ng C, Garriguet D, Tarasuk V. Household food insecurity is a stronger marker of adequacy of nutrient intakes among Canadian compared to American youth and adults. The Journal of Nutrition. 2015; 145 (7): 1596-1603. iii Roshanafshar S, Hawkins E. Food insecurity in Canada. Statistics Canada Catalogue no 82-624-X. Health at a Glance: Minister of Industry; 2015. iv Ontario Society of Nutrition Professionals in Public Health (OSNPPH). Position Statement on Responses to Food Insecurity [Report online]. Ontario: OSNPPH; 2015. v Tarasak V, Mitchell A, Fachner N. Household food insecurity in Canada, 2014 [Report Online]. Toronto: Research to identify policy options to reduce food insecurity (PROOF); 2016. vi Statistics Canada. Consumer Price Index, monthly, no seasonally adjusted, Ontario. May 2018 – May 2019. vii Health Canada. Evidence Review for Dietary Guidance – Technical Report 2015. viii Ontario Dietitians in Public Health. 2019 Monitoring Food Affordability Income Scenario Spreadsheet Backgrounder. 2019 507 CKF
CK Food Policy Council Minutes Wednesday March 13th 2019 - 5:30-7:30 pm Attendance: Ron, Derwyn, Coraine, Dina, Lyndsay, Carina, Rick, Sheri, Jennelle Arnew (guest), Anthony, Dr. Colby, Karen
Regrets: Carmen, David, Noreen, Allan, Mike, Phillip
1.0 Welcome – Ron welcomed everyone 2.0 Approval of Agenda – addition 6.3 Bring Food Home Conference, approved by Derwyn, Coraine 3.0 Approval of Minutes – approved by Dina, Karen 4.0 Working Groups 4.1 Food Access and Availability – Gleaning Update – last year was very successful as far as continued support from producers, new farmers that came on board, new volunteers and a wide variety of produce. For 2019, we will offer our two training classes but will also be working with the municipality to develop an online training program. 4.2 Food skills – Senior Centre Program Update –the food skills group has started to develop a “Make and Take” workshop to pilot with the Ridgetown Senior Centre. The workshop will include a manual for the workshop as well as a training guide for the volunteers leading the workshop. The workshop will include batch cooking, freezer meals, sheet pan dinners, and scalable meals. The workshop will also provide opportunities for new cookers, those who are looking for new meal ideas, meals that are simplified and reintroduce the joy of cooking.
5.0 Old Business 5.1 Training opportunities – Nutrition Resource Centre has had some really good webinars on food literacy that can be done either on the date or later when you have time. Feel free to check them out at https://opha.on.ca/Nutrition-Resource-Centre/Events/Past-Events.aspx
6.0 New Business 6.1 Food Strategy Update and Request for Participation– Jennelle Arnew and Lyndsay Davidson Jennelle, a Nutritionist with the CKPHU came to share information on the development of the Food Strategy. See attached presentation. She reviewed the mission, vision and values of the CKFPC and how this relates to the future work of the Food Strategy. She shared that previously we applied for a Trillium grant to help support this process but were unsuccessful. At this time we will be moving forward with support from the health unit as a lead to get this project completed. She shared examples of strategies from other communities including Hamilton and Toronto. Our strategy will look at both municipal departments as well as including groups in the community. One of the first steps that we will need to work on is learning about what is going on in our community. Jennelle provided a project overview that discussed the core working group will be a lead made up of key stakeholders and will support the community consultation. This will include surveys, interviews and focus groups. The timelines for the project will start around March 2019 with a plan to have a strategy to present the final report to the board of health in the first quarter (January to March 2020). The Governance Structure/Team Structure was shared showing responsibilities and process for approvals. Most important for the FPC is the core working group where we are requesting two members to sit at this table to help facilitate the process of creating the strategy. 508
MOTION: Dina, seconded by Dr. Colby - That the Food Policy Council will support the working group in the development of the Food Strategy. Discussion – it is a positive opportunity that will support the work of the FPC. Motion passed. ACTION: The Food Strategy is requesting two members from the FPC to sit on the Core Working Group representing the FPC. Rick put his name forward. If there is anyone else that is interested, please let Lyndsay know as soon as possible.
6.2 Marketing Plan – Review, Discussion and Approval – Caress has helped to create a marketing plan for us to use for the FPC. This is a starting point and was used for discussion as a group to help us determine what we would like to do. Attached is the final marketing plan that was developed. 6.3 Bring Food Home Conference – Lyndsay indicated that Sustain Ontario has revised how they are doing their Bring Food Home Conference for 2019. This year instead of doing one large conference they are asking for submission to host regional conferences/workshops (5 in total) across Ontario. The CK Public Health Unit along with Middlesex London and Windsor Essex Health Units have put in a submission to host a regional one in this area. The conference would be held in the fall and Lyndsay will update everyone when we hear back from them.
7.0 Update/sharing on happenings in Chatham-Kent – Everyone Derwyn – a new community garden is going in at the WISH Centre that will be used to train the children and also provide some produce into their salad bar and snack program. 8.0 Adjourned at 7:15 pm – motioned by Rick and seconded by Dina.
Next Meeting Dates: Individual Committee Meetings: Food Skills – 2nd Tuesday of the month – 5-7 pm – Health Unit, Room 302 Food Access and Availability – 3rd Tuesday of the month - 3-5 pm – Health Unit, 435 Grand Ave West, Room 302 (note the time change) Large Group Meeting: Wednesday May 8th, 2019, United Way Office 701
Municipality Of Chatham-Kent
Community Human Services
Public Health Unit
Information Report
To: Board of Health
From: Laura Zettler, Epidemiologist
Date: January 22, 2020
Subject: CK Public Health – Health Stats Portal ______
This report is for the information of the Board of Health.
Background
As outlined in the Ontario Public Health Standards (OPHS), public health units in Ontario are mandated to provide population health information to the public, community partners, public health practitioners, and other health care providers in order to increase awareness of relevant and current population health information and to inform local program planning. To date, local population health information has been provided to appropriate stakeholders by CK Public Health through reports, presentations, and other topic-based information products. There are also several publicly available web-based resources where population health data and indicators can be accessed at the health unit level. During 2019, while there was a focus on enhancing the public facing CK Public Health website and online presence of the organization, it was decided a local web-based portal could support efforts to disseminate population health information in a more timely and accessible way to stakeholders.
Comments
During the summer of 2019, a Masters of Public Health practicum student with CK Public Health supported the development of the framework for the new portal, extracted and collated publicly available population health indicators for Chatham-Kent and Ontario, and developed appropriate graphs with relevant interpretative text. The starting point for determining overall categories and specific indicators to include in the web- based resource was the list of Population Health Indicators to Support Public Health – Health System Collaboration. This indicator list was finalized in 2018 by a project committee established by the Ministry of Health and Public Health Ontario, in order to support integrated planning and collaboration between boards of health and health system partners. Furthermore, the initial indicator content (with the exception of the Infectious Disease category) was all extracted and collated from Public Health Ontario’s publically available online Snapshots tool (https://www.publichealthontario.ca/en/data- 702 CK Public Health - Health Stats 2
and-analysis/commonly-used-products/snapshots). All content was shared with HUB Creative to develop the Chatham-Kent Health Stats resource with a similar look and feel to the external facing CK Public Health website.
As of early 2020, Chatham-Kent Health Stats (https://ckhealthstats.com/) is a live public-facing website that provides information about the following population health topics:
• Behavioural Risk Factors • Chronic Disease • General Health • Infectious Diseases • Injury Prevention • Mental Health • Reproductive Health • Substance Use
Topics are explored using standard population health indicators as defined by the Association of Public Health Epidemiologists of Ontario (APHEO) or Statistics Canada where available. Data are presented in interpreted text and charts, and comparisons are presented between Chatham-Kent and Ontario, across age groups, between sexes, and over time where possible. There is a Resources section for more information on how to interpret the statistics provided and about the data sources analyzed to calculate the health indicators. Moving forward, additional topics/categories and indicators will be added to this resource as new content is developed and existing indicators will be updated when more current data is available. New and updated content will draw from existing publicly available sources of health indicators and from population health assessment and analysis completed within the Health Unit.
Consultation
The practicum student worked closely with the Public Health Epidemiologist through all aspects of indicator selection and content development. Similar resources from other public health units were explored to inform the framework for the local Health Stats portal. CK Public Health’s Community Outreach & Public Relations Officer supported and liaised with HUB Creative around site development and overall consistency between the public-facing websites.
Financial Implications
There are no financial implications. Costs incurred were covered within the current budget. 703
CK Public Health - Health Stats 3
Prepared by: Reviewed by:
______Laura Zettler, MSc Teresa Bendo, MBA Epidemiologist & Program Manager Director, Public Health
Reviewed by:
______April Rietdyk, RN, BScN, MHS, PhD PUBH General Manager Community Human Services
Attachment: None
This report addresses the following requirement(s) of the Ontario Public Health Standards: Foundational Standard – Population Health Assessment 1. The board of health shall conduct surveillance, including the ongoing collection, collation, analysis, and periodic reporting of population health information, as required by the Health Protection and Promotion Act and in accordance with the Population Health Assessment and Surveillance Protocol, 2018 (or as current). 2. The board of health shall interpret and use surveillance data to communicate information on risks to relevant audiences in accordance with the Healthy Environments and Climate Change Guideline, 2018 (or as current); the Infectious Diseases Protocol, 2018 (or as current); and the Population Health Assessment and Surveillance Protocol, 2018 (or as current). 3. The board of health shall assess current health status, health behaviours, preventive health practices, risk and protective factors, health care utilization relevant to public health, and demographic indicators, including the assessment of trends and changes, in accordance with the Population Health Assessment and Surveillance Protocol, 2018 (or as current). 6. The board of health shall provide population health information, including social determinants of health, health inequities, and other relevant sources to the public, community partners, and other health care providers in accordance with the Population Health Assessment and Surveillance Protocol, 2018 (or as current). 704 901
alPHa .Assodatio:n of Local PUBUC HEAL11H Agencies
Information Break
February 3, 2020
This update is a tool to keep alPHa's members apprised of the latest news in public health including provincial announcements, legislation, alPHa activities, correspondence and events.
Update on Public Health Modernization
On January 30, alPHa submitted its response to the Ministry of Health's discussion paper on public health modernization and shared a copy with all health units afterward. The submission followed a teleconference held the previous day between the alPHa Board of Directors and Ministry of Health representatives that included Jim Pine, Special Advisor. Mr. Pine updated the board on feedback received to date from stakeholders since the release of the discussion paper. He also noted that while several in-person consultations with stakeholders have been completed to date, others will be taking place in different regions over the next month or so. He further indicated that the February 10 cutoff to respond to the consultation paper is no longer a fixed deadline. Download alPHa's response on public health modernization Go to the Ministry of Health's public health consultations website alPHa invites health units and their boards to share their submissions to the provincial discussion paper with us by emailing them to Gordon Fleming at [email protected]. These will be uploaded to alPHa's dedicated resource page on public health modernization (link below), which contains announcements, responses and updates on related matters. Visit alPHa's Public Health Modernization resource web page 902
Novel Coronavirus
As part of the collective effort to communicate timely information about novel coronavirus (2019-nCoV), alPHa is attending daily ministry-led briefings and sending daily situation reports from the Ministry of Health to update health units on this emerging issue. COMOH members are monitoring the situation closely and, through the COMOH Chair, are in frequent contact with provincial officials, including Chief Medical Officer of Health Dr. David Williams, to ensure the health and well-being of the public. For convenience, alPHa has provided links to the Ministry's dedicated website and others on its home page and below. Go to the Ministry of Health's novel coronavirus website Visit the Ministry's page for health professionals here Go to Public Health Ontario's novel coronavirus website Visit the Government of Canada's website on novel coronavirus
Winter 2020 Symposium & Section Meetings alPHa looks forward to members' participation at the upcoming Winter 2020 Symposium and Section Meetings on February 20 and 21 at the Central YMCA in downtown Toronto. The not- to-miss program includes a leadership workshop led by Tim Arnold of Leaders for Leaders, a consultation session with Ministry of Health representatives on public health modernization, and an update from the Association of Municipalities of Ontario (AMO). For more information about this event, please click the link below. Register here to attend Visit the Winter 2020 Symposium & Section Meetings page
TOPHC 2020
Members are advised to register for TOPHC 2020 early and and book their preferred workshop as space is limited. The annual event will take place March 25-27 at the Beanfield Centre in Toronto. Highlights include keynotes on the impact of racism on communities' health, and how persuasive technologies (apps, games) can improve health and wellness behaviours. This year's HOT TOPHC focuses on the causes and characteristics of syndemics and their effect on health. Early bird promotional pricing ends February 12, so register soon. Learn more about TOPHC 2020 here Register for TOPHC 2020
Public Health News Roundup
Minister Elliott lauds public health's response to coronavirus - 2020/01/31
Ontario confirms third case of novel coronavirus - 2020/01/31 903
World Health Organization declares novel coronavirus a global public health emergency - 2020/01/30
British Columbia reports first presumed confirmed case of novel coronavirus - 2020/01/28
Ontario briefs leaders from colleges and universities on novel coronavirus and directs public to trusted information resources - 2020/01/28
Ontario confirms second presumptive case of novel coronavirus - 2020/01/27
Ontario briefs school boards' directors of education on novel coronavirus - 2020/01/26
Toronto reports first presumptive confirmed case of novel coronavirus - 2020/01/25
Ontario confirms first case of new coronavirus - 2020/01/25
Canada announces screening measures for novel coronavirus at major airports - 2020/01/24
US Surgeon General releases first report on smoking cessation in 30 years - 2020/01/23
Ontario Minister of Health designates novel coronavirus as a reportable disease - 2020/01/22
alPHa's New Address
In case you missed the announcement, alPHa relocated its office in December to 480 University Avenue, Suite 300, Toronto ON M5G 1V2. E-mails and phone numbers remain the same; however, our extensions are now three digits --a '2' has been added to the beginning of our previous extensions. Please update your records accordingly.
Upcoming Events - Mark your calendars!
Winter 2020 Symposium/Section Meetings - February 20 & 21, 2020, Central YMCA, 20 Grosvenor St., Toronto. Register here before the February 13 deadline. View the draft program.
The Ontario Public Health Convention (TOPHC) 2020 - March 25-27, 2020; Beanfield Centre, 105 Princes' Blvd., Toronto. Register here. Early bird registration ends February 12, 2020.
June 2020 Annual General Meeting & Conference - June 7-9, 2020, Chestnut Conference Centre, 89 Chestnut St., Toronto. View the notice and calls. alPHa is the provincial association for Ontario's public health units. You are receiving this update because you are a member of a board of health or an employee of a health unit. 904 905
Jackson Square, 185 King Street, Peterborough, ON K9J 2R8 J · • Peterborough P: 705-743-1000 or 1-877-743-0101 F: 705-743-2897 ~ ~ ~ Public Health peterboroughpublichealth.ca ~
January 29, 2020
The Honourable Caroline Mulroney Minister of Transportation Sent via e-mail: [email protected]
The Honourable Christine Elliott Minister of Health Sent via e-mail: [email protected]
Dear Honourable Ministers,
Re: Off Road Vehicles (ORV) and Bills 107 and 132
Peterborough Public Health (PPH) is mandated by the Ontario Public Health Standards and the Health Promotion and Protection Act to deliver public health programs and services that promote and protect the health of Peterborough City and County residents.1 One of our stated goals is to reduce the burden of preventable injuries, where road safety is an important factor. Given the Provincial Government’s recent passing of Bills 107 and 132, we anticipate changes to Ontario Regulation 316/03 are being drafted and wish to express several concerns and propose recommendations to consider. For the purpose of this letter, the term ORV is inclusive of all-terrain vehicles (ATVs), side-by-side ATVs, utility-terrain vehicles, and off-road motorcycles (i.e., dirt bikes), and does not include snowmobiles.
The popularity of ORVs has greatly increased over the last 30 years and with increased use, ORV-related injuries and deaths have also risen.2,3 In Canada in 2010 there were 435 ORV users seriously injured and 103 ORV-related fatalities. This compares to 149 seriously injured users in 1995 and 45 fatalities in 1990.2 These statistics are based on police reported data and medical examiner files. Hospital records are another source of data where Emergency Department (ED) visits, hospitalizations, and deaths may be identified to be caused by an ORV injury. In Ontario in 2015 to 2016, there were over 11,000 ORV-related ED visits and over 1,000 ORV- related hospitalizations.4 There have been between 29 and 52 fatalities each year relating to ORV or snowmobile use from 2005 to 2012.4 The most affected demographic group has been males aged 16-25.2,4 Rollovers, falling off the vehicle, and ejection are the most commonly cited mechanisms for ORV injury.4 The most common cause of death is due to head and neck injuries.4
ORV-related incidents are classified according to whether they occur on roadways (“traffic”) or off-roadways (“non-traffic”). Research indicates that there are higher rates of fatalities and serious injuries for ORV riders on roadways compared to off-roadways.5,6,7 Riding on roadways increases the risk of collisions with other motor vehicles.5,8,9 Also, design characteristics of certain classes of ORVs make them unsafe on roadways.5,10,11 Indeed, across the border in 2007 it was found that 65% of ATV rider deaths occurred on roads. There was also a greater increase in on-road than off-road deaths between 1998 and 2007, which coincided with more states increasing legal ATV access to roads in some way.11
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Some of the associated risk factors related to ORVs used in Ontario include alcohol and drug use, riding at night, lack of helmet use, and excessive speed.4,12 It has been found that the majority of ORV-related ED visits occur on the weekend (Friday to Sunday), and almost all are related to recreational use of ORVs.4
With these factors in mind, in revision of O. Reg 316/03, we recommend the following in PART III: Equipment requirements: o Maintain current* contents of section, ensuring content is up-to-date and is applicable to all classes of ORVs that will be permitted on roads. Operation requirements: o Maintain current* contents of section and requirements. Specifically: . Requiring the driver to hold a valid driver’s licence, with restrictions on number of passengers at night for novice young drivers; . Requiring all riders to wear an approved helmet; and . Setting maximum speed limits of 20 kilometres per hour, if the roads speed limit is not greater than 50 kilometres per hour, and 50 kilometres per hour, if the roads speed limit is greater than 50 kilometres per hour. o Under “Driver’s licence conditions”, include the condition that the blood alcohol concentration level of young or novice drivers be zero, as per the Highway Traffic Act (2019).
Finally, we encourage the Ministry of Transportation and the Ministry of Health to establish an effective communication strategy to educate all road users about forthcoming changes to ORV road-use laws, as well as to communicate the risks of riding ORVs on roads.
In summary, ORV-related accidents continue to be a significant cause of injury, with on roadway accidents resulting in higher proportions of severe injury (hospitalization) and fatalities than off roadway accidents. We appreciate your consideration of the safety implications of on-road ORV use as you revise O. Reg. 316/03.
If you have any questions or would like additional information about our comments, please contact Deanna Leahy, Health Promoter, at 705-743-1000 ext. 354, [email protected].
Sincerely,
Original signed by
Mayor Andy Mitchell Chair, Board of Health cc: The Hon. Doug Ford, Premier of Ontario Dr. David Williams, Chief Medical Officer of Health Local MPPs Opposition Health Critics The Association of Local Public Health Agencies Ontario Boards of Health
*“current” refers to O. Reg. 316/03: Operation of off-road vehicles on highways, dated January 1, 2018
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References
1. Ontario Ministry of Health and Long-term Care. (2018). Ontario Public Health Standard: Requirements for Programs, Services, and Accountability. Toronto, ON: Author. 2. Vanlaar, W., McAteer, H., Brown, S., Crain, J., McFaull, S., & Hing, M. M. (2015). Injuries related to off-road vehicles in Canada. Accident Analysis & Prevention, 75, 264-271. 3. Canadian Paediatric Society. (2015). Are we doing enough? A status report on Canadian public policy and child and youth health. Ottawa (ON): Canadian Pediatric Society. Retrieved from http://www.cps.ca/uploads/status-report/sr16-en.pdf. 4. Ontario Agency for Health Protection and Promotion (Public Health Ontario), Chu A, Orr S, Moloughney B, McFaull S, Russell K, Richmond SA. The epidemiology of all-terrain vehicle- and snowmobile-related injuries in Ontario. Toronto, ON: Queen’s Printer for Ontario; 2019. 5. Denning, G. M., Harland, K. K., Ellis, D. G., & Jennissen, C. A. (2013). More fatal all-terrain vehicle crashes occur on the roadway than off: increased risk-taking characterises roadway fatalities. Injury prevention, 19(4), 250-256. 6. Williams, A. F., Oesch, S. L., McCartt, A. T., Teoh, E. R., & Sims, L. B. (2014). On-road all-terrain vehicle (ATV) fatalities in the United States. Journal of safety research, 50, 117-123. 7. Denning, G. M., & Jennissen, C. A. (2016). All-terrain vehicle fatalities on paved roads, unpaved roads, and off-road: Evidence for informed roadway safety warnings and legislation. Traffic injury prevention, 17(4), 406-412. 8. Yanchar NL, Canadian Paediatric Society Injury Prevention Committee. (2012). Position statement: Preventing injuries from all-terrain vehicles. Retrieved from http://www.cps.ca/en/documents/position/preventing-injury-from-atvs. 9. Ontario Medical Association. (2009). OMA Position Paper: All-Terrain Vehicles (ATVs) and children’s safety. Ontario Medical Review, p. 17–21. 10. Fawcett, V. J., Tsang, B., Taheri, A., Belton, K. & Widder, S. L. (2016). A review on all terrain vehicle safety. Safety, 2, 15. 11. Consumer Federation of America. (2014). ATVs on roadways: A safety crisis. Retrieved from https://consumerfed.org/pdfs/ATVs-on-roadways-03-2014.pdf. 12. Lord, S., Tator, C. H., & Wells, S. (2010). Examining Ontario deaths due to all-terrain vehicles, and targets for prevention. The Canadian Journal of Neurological Sciences, 37(03), 343-349.
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Public Health Modernization Discussion Paper Response Submitted to the Public Health alPHa Modernization Team Association of Local PUBLIC HEALTH Agencies
The Association of Local Public Health Agencies (alPHa) is pleased to present the following response to the Public Health Modernization Discussion Paper. We invited our members to provide answers to the questions that are posed in the paper to help us identify themes common to the local public health sector throughout the province. This feedback has been synthesized and presented within the framework of themes and questions laid out in the consultation survey. alPHa’s response is intended to be complementary to the individual responses of its members, not a summary or a substitute. alPHa urges the Public Health Modernization team to take the unique local circumstances and perspectives presented in its members’ and partners’ direct feedback to the survey and in-person consultations into careful consideration as it formulates its advice to the Minister.
PREAMBLE and PRINCIPLES alPHa agrees with the Ministry’s vision of a “coordinated public health sector that is nimble, resilient, efficient and responsive to the province’s evolving health priorities”. alPHa also agrees with improving consistency where it makes sense to do so and improving clarity and alignment of the related roles and responsibilities of the province, Public Health Ontario (PHO), and local public health. alPHa certainly agrees that enhanced investment in health promotion and prevention will be critical to the success of Ontario’s plan to end hallway health care.
In November of 2019, alPHa transmitted its Statement of Principles for Public Health Modernization to the Minister and the Public Health Modernization Team and these remain the foundation of alPHa’s present response. These principles are incorporated into the responses to the survey questions as appropriate and the full document is attached.
The foundational principle is that any and all changes must serve the goal of strengthening the Ontario public health system’s capacity to improve population health in all of Ontario’s communities through the effective and efficient local delivery of evidence-based public health programs and services. Public health unit (PHU) realignments, identification of efficiencies, clarification of roles and strengthening of institutional relationships must all have that central aim as their starting point.
It must be recognized that Ontario already has an enviable public health system, based on a network of 34 PHUs with expert staff, strong partnerships and a clear and authoritative mandate to protect and promote health within their local communities. These are supported by the central research and evidence functions of PHO and the oversight of the Chief Medical Officer of Health (CMOH) within the Ministry. Building on the Ontario system’s existing strengths must be the strategic foundation for any proposed changes.
alPHa Response: Public Health Modernization Discussion Paper Page 1 of 13 910
Theme: Insufficient Capacity
What is currently working well in the public health sector?
• Actions taken in response to the Walkerton and SARS crises in the early 2000s (e.g., increased provincial responsibility for funding, strengthened role of the Chief Medical Officer of Health (CMOH), creation of PHO) have led to measurable improvements to the Ontario public health sector’s capacity to detect and respond to emerging threats. The swift collective and thorough response to the developing Novel Coronavirus (2019-nCoV) epidemic is a clear application by Ontario’s public health sector of the lessons learned from the 2003 SARS outbreak.
• Ontario’s public health sector is already an effective network of 34 local public health units (PHUs)with a strong and detailed mandate to identify and meet the health protection and promotion needs of their communities. That mandate is clearly spelled out in the Health Protection and Promotion Act (HPPA) and the Ontario Public Health Standards (OPHS), with explicit flexibility built in to ensure that programs and services can be adapted according to local circumstances.
• Within each of the existing PHUs’ boundaries, strong partnerships have been forged with local municipalities, social services, school boards and health care providers among others to support this work.
• The sector benefits from the collaborative work of province-wide professional (e.g., alPHa, COMOH, ASPHIO, ODPH, OPHNL, APHEO) and topic-specific (e.g. TCAN, LDCP) groups. These groups provide ongoing opportunities for collaboration and information exchange across PHU boundaries throughout Ontario.
• There is clear public and political recognition of the critical importance of investments in health protection and promotion to improving population health and ensuring the sustainability of the health care system.
• There is an invaluable range of professional, political and technical expertise resident in the public health sector (public health physicians, elected officials, epidemiologists, nurses, public health inspectors, health promoters, policy analysts, dentists, dietitians, business administrators, lawyers and highly skilled support staff).
• Local representation on boards of health (in a variety of models that includes elected municipal officials in all cases, with provincial appointees and citizen representatives serving in many) reflects community characteristics and values within the PHU boundary and provides direct accountability.
• Collaboration among PHUs including the development of consistency of practice (e.g., HIV case management, immunization enforcement in schools and child care centres, infection prevention and control inspections in the health care sector, electronic medical record use, records retention policies), mutual aid agreements, cross-coverage, outbreak management, and voluntary mergers (Southwestern and Huron-Perth).
• PHO is a unique and invaluable resource within the sector that has strong roles in research, professional development, ethics review, knowledge translation and response to emerging threats. alPHa Response: Public Health Modernization Discussion Paper Page 2 of 13 911
• The cost-sharing model provides the framework to ensure a stable and predictable source of adequate funding for public health programs and services while ensuring accountability at both the provincial and municipal levels.
• PHUs with large populations have budgets that allow them to deliver services efficiently and cost- effectively while also ensuring surge capacity.
• PHUs that are integrated with Regions (e.g., Halton, Durham) and cities (e.g., Toronto, Ottawa) benefit from support services (e.g. administrative, IT) embedded within those structures. This integration also facilitates coordination among public health, social services, emergency health services and public works.
What are some changes that could be considered to address the variability in capacity in the current public health sector?
• Formal mechanisms and commitment at both the provincial and municipal levels to ensure that the total annual public health funding envelope is stable, predictable, protected and sufficient to cover all costs for the full delivery of all public health programs and services in all PHUs whether they are mandated by the province or developed to serve unique local needs as authorized by Section 9 of the HPPA.
• Provincial support for voluntary mergers of PHUs with complementary characteristics where it can be demonstrated that functional capacity will be improved. Any realignments of present PHU boundaries must be considered only to ensure critical mass to efficiently and equitably deliver public health programs and services. As a general rule, existing PHUs should be left intact, particularly with regard to municipal boundaries, and complementary geographic, demographic and organizational characteristics should be key factors in deciding which mergers should be considered. Evidence about the relationship between critical population mass and the effective allocation of public health resources should also be examined.
• Enhance centralized provincial supports, to increase efficiency and the capacity of all public PHUs to deliver the full scope of the OPHS. PHO already has important research and evidence roles but is also well-positioned to coordinate the strengths of different PHUs. Provincial-level strategic and topic-specific advisory tables that include PHO, the CMOH and local public health leadership have also proven very useful in the past.
• In partnership with local public health, educational institutions and other relevant organizations, develop a provincial public health human resources strategy to build on the successful recruitment and retention of a skilled and competent public health workforce. Maintaining the visibility of the public health sector, demonstrating its stability and importance, presenting the wide range of opportunities within it, providing incentives to work in remote areas and keeping salaries competitive will be vital components.
• Increase decision-making flexibility at the local level to develop their own models for the provision of mandated services according to local circumstances and resources, as well as to develop more formal arrangements to share resources if surge capacity is needed (e.g. epidemiology, analysis, evaluation).
What changes to the structure and organization of public health should be considered to address these challenges? alPHa Response: Public Health Modernization Discussion Paper Page 3 of 13 912
• alPHa does not believe that systemic structural and organizational changes are necessary to address capacity challenges. As we have demonstrated in our answers to the other discussion questions, any capacity issues can be appropriately addressed within the existing framework by building on its strengths.
• Capacity for most PHUs has been steadily eroding over the years largely due to the Ministry putting caps (often 0%) on annual budget increases that are necessary to cover the costs of delivery of new programs, annual Consumer Price Index (CPI) increases and honouring collective agreements. This erosion will be significantly magnified by the Province’s decision to shift 5% of the cost-shared and 30% of previously 100% provincially funded public health programs to municipalities. More details on this were presented by alPHa to the Standing Committee on Finance and Economic Affairs on January 17, 2020 as part of its pre-budget consultation. Speaking notes and the transcript of this presentation are linked above and attached below.
• The autonomy of each local board of health (BOH) must be maintained and stronger mechanisms should be considered to reinforce their sole focus on and local decision-making authority over public health matters as well as to protect them from intrusive policies (e.g., municipal hiring freezes, vacancies on local boards and Associate Medical Officer of Health (AMOH) positions due to inappropriate delays in the provincial appointment and approval processes).
• Several organizational considerations are outlined in the attached alPHa Statement of Principles.
Theme: Misalignment of Health, Social, and Other Services
What has been successful in the current system to foster collaboration among public health, the health sector and social services?
• alPHa respectfully observes that the use of the term “misalignment” in the wording of this theme is misleading, as it creates the false impression that misalignments are a significant systemic problem. On the contrary, PHUs are very well aligned with municipalities, social services, school boards and other community-based services and partners. Previous proposals to align PHU boundaries with those of the health sector (i.e., LHINs) has threatened these existing local relationships without demonstrating the necessity for doing so. If misalignments in certain areas are identified, they must be measured against and prioritized in context of existing alignments in others.
• The reciprocal mandate between the local MOH and LHIN CEO became an important enabler for public health’s relationship with the health care sector and this is being expanded upon with most PHUs having direct involvement in the new Ontario Health Teams (OHTs).
• Our members provided us with many specific examples of successful local collaborations with the health care sector related to such topics as injury prevention, substance use, perinatal health, infectious disease prevention and health equity in program design. These will surely be presented in more detail in their individual submissions to the present survey.
• Our members provided us with many specific examples to demonstrate the strength of local collaboration with social services, boards of education and community agencies. The existing geographical alignments of these different groups was cited as critically important. Where public health is integrated within a municipal or regional government, links to their social services alPHa Response: Public Health Modernization Discussion Paper Page 4 of 13 913
departments are particularly strong. In other cases, formal service agreements and partnerships are highly dependent on shared community boundaries and characteristics.
• The OPHS are explicit in their requirement of all boards of health to carry out their mandated obligations in partnership with local stakeholders. Public health is in turn seen as a credible broker within the local community that can support multi-stakeholder engagement and community mobilization for healthy public policy.
How could a modernized public health system become more connected to the health care system or social services?
• Strengthen the health and social services sectors’ focus on prevention and the social determinants of health. Explore the implementation of a “health in all policies” approach with parallel mandates, clear role expectations and accountability for protecting population health across related provincial government ministries and government-funded agencies.
• The Ministry of Health (Ministry) could provide a reciprocal and clearly defined mandate for PHUs and OHTs to utilize public health’s surveillance and analysis expertise to conduct population-based needs assessments to inform the effective local allocation of primary health care resources and build capacity among health service providers to offer evidence-based health promotion and prevention interventions.
• Improvements to information technology to support interoperability and data standards to accelerate the appropriate inclusion of public health information into electronic health records and facilitate public health’s receipt of vital information from primary care and the broader health care system. This collaboration would support disease prevention and health promotion at the individual to population-level to end hallway health care. More details on digital modernization will be provided in a separate submission by the COMOH Digital Health Committee.
What are some examples of effective collaborations among public health, health services and social services?
• Our members provided us with many specific examples of successful local collaborations among public health, health services and social services. These will surely be presented in more detail in their individual submissions to the present survey.
• The mandated reciprocal relationship between the local Medical Officer of Health (MOH) and Local Health Integration Network (LHIN) CEO was cited as instrumental in promoting a better understanding of public health’s mandate, focus and functions to the health care conversation. Direct involvement of public health in local OHTs is expected to increase the momentum.
• The partnership between the Council of Ontario Directors of Education and COMOH (CODE- COMOH) is expected to contribute to the well-being of Ontario's children and students through enhancing PHU and school board partnerships in order to achieve optimal delivery of services and ongoing supports for children and students.
Theme: Duplication of Effort
As with the previous theme, alPHa would argue that the use of the term “Duplication of Effort” suggests that it is a systemic problem that underlies widespread inefficiencies. While we agree that alPHa Response: Public Health Modernization Discussion Paper Page 5 of 13 914
there are public health functions that could in fact be carried out jointly, regionally or centrally, the local nature of public health requires certain programs and services with similar aims to be developed and implemented in different ways to meet unique local needs.
Care must therefore be taken in defining the term and in identifying and eliminating duplication that is in fact redundant. Care must also be taken when examining alleged duplication of effort between sectors. Public health has a unique set of roles and responsibilities and it would be a mistake to assume that they are transferrable. For example, health promotion in public health differs fundamentally from health promotion in primary care. Only public health focuses on upstream population-level approaches to prevent injuries and illnesses before they occur, and success often depends on strong existing relationships with community partners.
What functions of public health units should be local and why?
• The health protection functions of public health are local by definition. Health hazard investigation and response, infection prevention and control, communicable disease outbreak management, water quality and food safety are examples of areas where local public health has clearly prescribed and detailed roles and responsibilities under the HPPA and OPHS. Carrying these out relies heavily on interaction with individuals, institutions, businesses and service providers throughout the local community. Timeliness and efficiency are supported by preexisting positive relationships.
• Health promotion work is also informed in large part by understanding the local population’s characteristics, identifying local priorities and strategically developing approaches for policy development and program and service delivery that will be most responsive to local population health needs. Ongoing population health assessment and surveillance ensures that local data are at the root of program planning as well as healthy public policy development through public health’s relationship with municipalities.
• Some public health services (e.g. harm reduction, screening programs, prenatal education, Healthy Babies Healthy Children, neighbourhood groups) focus on individuals and families with high needs. Public health’s knowledge of the community and partnerships are a valuable resource for connecting clients with necessary services, which are also primarily local.
What population health assessments, data and analytics are helpful to drive local improvements?
• The epidemiological capacity to collect and access data to conduct detailed local population health assessments within local contexts must be enhanced. Public health programs and services benefit from solid data at the sub-health unit level (e.g., priority neighbourhoods, planning zones, ER admissions). Local epidemiologists have a keen understanding of the local context and are well positioned to collaborate with stakeholders to gather data, conduct analysis and inform recommendations for action and priority setting.
• The CMOH’s 2017 Annual Report recommended a provincial population health survey to collect data at the local community and neighbourhood levels to contribute to a better understanding of community wellness. The survey would need to be flexible and nimble, with the ability to customize questions to local needs.
• The Rapid Risk Factor Surveillance System is an ongoing local health telephone survey conducted collaboratively since 2001 by numerous PHUs and the Institute for Social Research at York alPHa Response: Public Health Modernization Discussion Paper Page 6 of 13 915
University. Information is gathered using questionnaires on a wide variety of health topics to inform service planning for the broad range of public health programs that are required by the OPHS, to advocate for healthy public policy development and to improve community awareness of health risks.
• Strategies to identify and address gaps in data and information must be considered. The Children Count Locally Driven Collaborative Project is an important current example of a strategy to improve available data and interventions to improve child and youth health in Ontario.
What changes should the government consider to strengthen research capacity, knowledge exchange and shared priority setting for public health in the province?
• alPHa believes that the most important development in this regard was the establishment of the Ontario Agency for Health Protection and Promotion, a.k.a. PHO. PHO has been instrumental in supporting our health protection activities with excellent standards of practice developed in communicable disease control, vaccination, and infection prevention and control. We believe that there is an important opportunity to reinforce PHO’s capacity to strengthen similar work in the areas of environmental health and non-communicable diseases (which account for over 70% of ill health in Ontario) by focusing on evidence, translating it into recommended practice, and setting common implementation standards. PHO is the key agency for scientific expertise, research and knowledge exchange and is one of the Ontario public health sector’s strongest assets. This is one of the strengths that needs to be built upon as the Ministry seeks to achieve the outcomes outlined in this discussion paper.
What are public health functions, programs or services that could be strengthened if coordinated or provided at the provincial level? Or by Public Health Ontario?
• As noted above, the existing roles and responsibilities of PHO should be reinforced and expanded.
• Increased centralized supports, provided by PHO or the Ministry, have the potential to reduce duplication of effort, and contribute to increased consistency and improved delivery of public health programs and services. Examples include a provincial immunization registry, provincial electronic medical records, centralized digital supports including facilitation of data sharing, provincial health communication campaigns, continuing professional education opportunities, centralized reviews of evidence, bulk purchasing, access to data repositories, provincial advisory committees etc. Centralized supports must be designed to sustain the local capacity to develop and implement innovative and locally relevant campaigns.
• Developing provincial leadership on surveillance and population health assessment, technical direction (especially on emerging public health issues), emergency management, healthy policy development and chronic disease prevention coordination. Setting provincial population health goals with targets and cross-sectoral strategies would be a useful foundation upon which to carry out these functions.
• The Ministry, likely via the independent authority of the CMOH, needs to be more active in providing local public health with guidance and / or direction when asked to ensure consistent approaches where there is agreement that they are required. There have been instances (ISPA enforcement, IPAC investigations and HIV Case management for recent examples) where local public health asked for direction to address disparate and sometimes conflicting local practices. With none provided, local MOHs were compelled to work together to develop their alPHa Response: Public Health Modernization Discussion Paper Page 7 of 13 916
own recommendations for a collective approach.
Beyond what currently exists, are there other technology solutions that can help to improve public health programs and services and strengthen the public health system?
• The COMOH Digital Health Committee will be making a detailed submission to the Public Health Modernization consultation. It will call on the Province to develop a digital strategy for public health; provide sufficient resources to support aligned and necessary information systems and common applications; work with public health partners to facilitate the incorporation of public health information into a provincial electronic health record; centralized coordination and technical support for digital solution integration and Provincial leadership on data standards and interoperability.
• Other suggestions put forth by our members included bulk purchasing of information technology hardware and software, a centralized website with important public health information, a seamless provincial immunization registry, a centralized online inspection disclosure system, enhanced technology to reduce travel requirements (e.g., video calls for client interactions and videoconferencing for health unit staff in rural areas). Inequities in access to technology solutions and tech-mediated opportunities for collaboration were also raised. We expect that many other suggestions will be made in other submissions to the survey question.
Theme: Inconsistent Priority Setting
As with previous themes, alPHa would argue that the use of the term “Inconsistent Priority Setting” suggests a systemic problem that underlies widespread inefficiencies. The existence of different public health priorities in different parts of the province is a feature of the system, not a bug, and is one of its strengths. Local authority over priority setting must be preserved to ensure that the unique health needs of each community can be served. This should include the authority to adapt programs and services to address province-wide public health priorities according to the local context.
What processes and structures are currently in place that promote shared priority setting across public PHUs?
• PHUs are required, through the HPPA, to meet the requirements of the OPHS. These standards provide a framework to support consistent priority setting across Ontario and the related Accountability Agreements ensure provincial approval and awareness of each BOH’s plan for the delivery of mandated programs and services each year.
• Ontario’s 34 PHUs are connected to a wide range of networks that provide opportunities for sharing of information, priority setting and collective action. alPHa, including COMOH, BOHs and Affiliate Sections, is the most important of these at the systemic level as it brings the governance, medical and programmatic aspects of the entire system together at a single table, which in turn provides an ideal point of contact for government and other stakeholders.
• Profession-specific associations such as ASPHIO, OPHNL, APHEO, AOPHBA, OAPHD, ODPH and HPO provide similar opportunities for the collective identification of priorities within their purview. Each of these groups is represented at the alPHa table.
• Topic-specific collaboratives, spanning regions or the province, provide opportunities to share information and resources, and to collectively address common goals. For example, regional alPHa Response: Public Health Modernization Discussion Paper Page 8 of 13 917
TCANs allow for shared priority setting and planning related to reducing smoking behavior in regions spanning multiple PHUs. Similar collaborative groups have addressed cannabis, alcohol and opioids.
• Regional PHU groupings (South West, Central West, Central East, North East, North West, East) are networks that provide similar opportunities for neighbouring PHUs that share geographic and demographic characteristics.
• 100% provincially funded public health programs (e.g. Universal Influenza Immunization Program, Ontario Seniors Dental Care Program (OSDCP)) are a clear demonstration of priorities that are shared province wide.
What should the role of Public Health Ontario be in informing and coordinating provincial priorities?
• PHO’s mandate is to provide a foundation of sound information, knowledge and evidence to support policy, action and decisions of government, public health practitioners, front-line health workers and researchers. Centralized and timely evidence reviews, provision of provincial and local data, guidance documents and best practices, research ethics, and coordination of tables to address significant province-wide needs (e.g., Healthy Human Development table, Provincial Infectious Disease Advisory Committee) are key functions that underlie evidence-based setting of priorities throughout the public health sector. Reinforcing PHO’s capacity to perform these functions in the areas of health promotion and non-communicable disease prevention should be considered.
• PHO’s “hub and spoke” model, which was the basis for the former Regional Infection Control Networks, could be used to establish collaborative regional tables in the various public health areas of focus to inform common priorities and joint projects. Such an approach would be valuable in setting province-wide priorities as common themes emerge.
• PHO would be instrumental in providing the evidentiary basis for the establishment of provincial population health goals as proposed above.
What models of leadership and governance can promote consistent priority setting?
• A model of leadership and governance to promote consistent priority setting is already in place. The HPPA provides a clear, detailed and specific framework for the organization and delivery of public health programs and services, including the composition, authority and duties of boards of health. The HPPA is in turn the enabling legislation for the OPHS, which set out clear, detailed and specific requirements for the delivery of public health programs and services in each of the province’s 34 PHUs.
• The Office of the CMOH is responsible for ensuring that the OPHS continue to be relevant and based on evidence, and for supporting local public PHUs in meeting the requirements of the standards. Each BOH is required to submit annual business plans to the Ministry through this office as part of the budget and accountability processes.
• Leadership and governance principles are outlined in the attached alPHa Statement, including preserving the autonomy and authority of the local MOH and reinforcing local boards’ autonomy, skill sets, effective governance and public health focus. alPHa Response: Public Health Modernization Discussion Paper Page 9 of 13 918
Theme: Indigenous and First Nation Communities
What has been successful in the current system to foster collaboration among public health and Indigenous communities and organizations?
• PHUs with significant indigenous populations long ago identified the importance of improving their access to public health programs and services, especially in First Nations communities. Many have independently entered into formal agreements with local bands under Section 50 of the HPPA for the provision of programs and services.
• The 2018 OPHS added a requirement for boards of health to engage with First Nations and Indigenous communities and organizations under the Health Equity Standard. The Relationship with Indigenous Communities Guideline, 2018 was developed to support this work and a Relationship with Indigenous Communities Toolkit is said to be under development by the Ministry.
• The widespread acceptance of and commitment to the Truth and Reconciliation Calls to Action throughout the public health sector. Staff training in cultural awareness / competency /safety, the local involvement of Indigenous leaders in decision making, program planning and relationship development, and local partnerships and initiatives have sprung forth from that commitment in all of Ontario’s PHUs.
Are there opportunities to strengthen Indigenous representation and decision- making within the public health sector?
• In its Statement of Principles, alPHa notes the necessity of special consideration being given to the effects of any proposed organizational change on Ontario’s many Indigenous communities, especially those with a close relationship with the boards of health for the PHUs within which they are located. It is further notes that opportunities to formalize and improve these relationships must be explored as part of the modernization process. alPHa recommends that this exploration, including consideration of the above question, be conducted in full consultation with Indigenous communities and organizations as well as boards of health that have already demonstrated commitment to and experience with Indigenous engagement and service delivery to these populations.
• In its Statement of Principles, alPHa recommends that local BOHs be reflective of the communities that they serve. In areas with large indigenous populations and / or First Nations communities, consideration should be given to appointing one or more members of those communities to the BOH itself. This has already been done, for example, in Peterborough. This could be reinforced with the formation of local Indigenous health advisory committees with more widespread stakeholder involvement. These committees would be especially important for identifying and addressing the health needs of Indigenous people living off-reserve in a culturally sensitive way.
• Provincially, the Office of the CMOH should ensure that central resource and policy supports are in place to facilitate local engagement with Indigenous communities and reinforce pathways to increasing representation and decision-making. The Health Equity requirements of the OPHS that are specific to improving the health of First Nations, Métis, and Inuit people living in Ontario should be the foundation of these supports. The CMOH will also have an important role to play as a liaison with the Government of Canada (through the Public Health Agency of Canada) to ensure that it abides by its complementary obligation to contribute to the improvement of health care and health outcomes for these communities. alPHa Response: Public Health Modernization Discussion Paper Page 10 of 13 919
Theme: Francophone Communities
What has been successful in the current system in considering the needs of Francophone populations in planning, delivery and evaluation of public health programs and services?
• alPHa’s members have extensive experience in providing programs and services aimed at different cultural and linguistic groups within their communities, including Ontario’s significant Francophone population. PHUs with significant Francophone populations are best equipped to share what has been successful, identify the gaps and provide advice on how to address them. This is in fact a good example of the importance of ensuring that local boards of health retain decision-making authority over program planning and service delivery to best serve local needs.
What improvements could be made to public health service delivery in French to Francophone communities?
• The provision of a 100% provincially funded centralized translation service that is accessible to all boards of health was cited repeatedly in our members’ feedback to this question, as was support for French-language training programs for health unit staff.
Theme: Learning from Past Reports
What improvements to the structure and organization of public health should be considered to address these challenges?
• Most past reports have recommended PHU mergers, and alPHa is not opposed to this in principle, as long as such mergers are of entities with complementary community characteristics and values, will lead to a demonstrable positive impact on capacity, are worth the extraordinary cost and disruption, and are favoured by all concerned parties. The Simcoe-Muskoka, North Bay-Parry Sound, Southwestern and Huron-Perth PHUs are the results of mergers that have taken place since 2005, and valuable insights on the process, including the identification of driving forces, key success factors and challenges, are readily available.
• As noted above, alPHa does not believe that structural and organizational changes are necessary to address capacity challenges. While we agree that health unit mergers as a means to finding efficiencies and reducing duplication of efforts are worth considering, we have not been presented with a clear and convincing argument that a wholesale restructuring of the Ontario’s public health system – with its concomitant major costs and disruptions - is a prerequisite for making it nimble, resilient, efficient and responsive.
What about the current public health system should be retained as the sector is modernized?
From alPHa’s Statement of Principles:
• Ontario’s public health system must remain financially and administratively separate and distinct from the health care system.
• The strong, independent local authority for planning and delivery of public health programs and services must be preserved, including the authority to customize centralized public health programming or messaging according to local circumstances. alPHa Response: Public Health Modernization Discussion Paper Page 11 of 13 920
• Parts I-V and Parts VI.1 – IX of the HPPA should be retained as the statutory framework for the purpose of the Act, which is to “provide for the organization and delivery of public health programs and services, the prevention of the spread of disease and the promotion and protection of the health of the people of Ontario”.
• The OPHS should be retained as the foundational basis for local planning and budgeting for the delivery of public health programs and services.
• The leadership role of the local MOH as currently defined in the HPPA must be preserved with no degradation of independence, leadership or authority.
What else should be considered as the public health sector is modernized?
• Any and all changes must serve the goal of strengthening the Ontario public health system’s capacity to improve population health in all of Ontario’s communities through the effective and efficient local delivery of evidence-based public health programs and services.
• Achieving efficiencies must be defined in terms of improvements to service delivery and not cost savings. Each of the completed health unit mergers for example has had the former as their central aim but the merger process itself has always been costly.
• Provincial supports (financial, legal, administrative) must be provided to assist existing local PHUs in their transition to any new state without interruption to front-line services. Any costs associated with Public Health Modernization should be fully covered by the Ministry, including additional funding to address technology changes associated with any structure or governance changes.
• alPHa is very pleased with the format and process of the current consultation. That said, in the period between the initial 2019 budget announcement and the formal launch of this consultation (a period of over seven months), there was an unacceptable scarcity of information available to Ontario’s considerable public health workforce. This has had a measurable and possibly irreversible negative impact on culture and morale within Ontario’s public health workplaces. It has also put a considerable hindrance on the working relationship between local public health leadership and its partners within the Ministry. We hope that the transparency, comprehensiveness and reciprocity of this consultation will continue throughout the analysis and implementation phases to restore trust and demonstrate that the Government of Ontario values the public health professionals that are the foundational strength of the system.
alPHa Response: Public Health Modernization Discussion Paper Page 12 of 13 921
ABBREVIATIONS
alPHa Association of Local Public Health Agencies AOPHBA Association of Ontario Public Health Business Administrators APHEO Association of Public Health Epidemiologists in Ontario ASPHIO Association of Supervisors of Public Health Inspectors of Ontario BOH Board of Health CMOH Chief Medical Officer of Health COMOH Council of Ontario Medical Officers of Health HPO Health Promotion Ontario HPPA Health Protection and Promotion Act HIV Human Immunodeficiency Virus IPAC Infection Prevention and Control ISPA Immunization of School Pupils Act LDCP Locally Driven Collaborative Project OAPHD Ontario Association of Public Health Dentistry OPHNL Ontario Association of Public Health Nursing Leaders ODPH Ontario Dietitians in Public Health OPHS Ontario Public Health Standards PHO Public Health Ontario PHU Public Health Unit TCAN Tobacco Control Area Network
Enclosures: alPHa Statement of Principles (November 2019), also attached. alPHa Deputation, Standing Committee on Finance and Economic Affairs (January 17, 2020), also attached
alPHa Response: Public Health Modernization Discussion Paper Page 13 of 13 922
Statement of Principles alPHa Public Health Modernization Association of Local November 2019 PUBLIC HEALTH Agencies
BACKGROUND
On April 11, 2019 the Minister of Finance announced the 2019 Ontario Budget, which included a pledge to modernize “the way public health units are organized, allowing for a focus on Ontario’s residents, broader municipal engagement, more efficient service delivery, better alignment with the health care system and more effective staff recruitment and retention to improve public health promotion and prevention”.
Plans announced for this initiative included regionalization and governance changes to achieve economies of scale, streamlined back-office functions and better-coordinated action by public health units, adjustments to the provincial-municipal cost-sharing of public health funding and an emphasis on digitizing and streamlining processes.
On November 6, 2019, further details were presented as part of the government’s Fall Economic Statement, which reiterates the Province’s consideration of “how to best deliver public health in a way that is coordinated, resilient, efficient and nimble, and meets the evolving health needs and priorities of communities”. To this end, the government is renewing consultations with municipal governments and the public health sector under the leadership of Special Advisor Jim Pine, who is also the Chief Administrative Officer of the County of Hastings. The aim of the consultation is to ensure:
• Better consistency and equity of service delivery across the province; • Improved clarity and alignment of roles and responsibilities between the Province, Public Health Ontario and local public health; • Better and deeper relationships with primary care and the broader health care system to support the goal of ending hallway health care through improved health promotion and prevention; • Unlocking and promoting leading innovative practices and key strengths from across the province; and • Improved public health delivery and the sustainability of the system.
In preparation for these consultations and with the intent of actively supporting positive systemic change, the alPHa Board of Directors has agreed on the following principles as a foundation for its separate and formal submissions to the consultation process.
alPHa Statement of Principles - Public Health Modernization November 2019 Page 1 923
PRINCIPLES
Foundational Principle
1) Any and all changes must serve the goal of strengthening the Ontario public health system’s capacity to improve population health in all of Ontario’s communities through the effective and efficient local delivery of evidence-based public health programs and services.
Organizational Principles
2) Ontario’s public health system must remain financially and administratively separate and distinct from the health care system.
3) The strong, independent local authority for planning and delivery of public health programs and services must be preserved, including the authority to customize centralized public health programming or messaging according to local circumstances.
4) Parts I-V and Parts VI.1 – IX of the Health Protection and Promotion Act should be retained as the statutory framework for the purpose of the Act, which is to “provide for the organization and delivery of public health programs and services, the prevention of the spread of disease and the promotion and protection of the health of the people of Ontario”.
5) The Ontario Public Health Standards: Requirements for Programs, Services, and Accountability should be retained as the foundational basis for local planning and budgeting for the delivery of public health programs and services.
6) Special consideration will need to be given to the effects of any proposed organizational change on Ontario’s many Indigenous communities, especially those with a close relationship with the boards of health for the health units within which they are located. Opportunities to formalize and improve these relationships must be explored as part of the modernization process.
Capacity Principles
7) Regardless of the sources of funding for public health in Ontario, mechanisms must be included to ensure that the total funding envelope is stable, predictable, protected and sufficient for the full delivery of all public health programs and services whether they are mandated by the province or developed to serve unique local needs as authorized by Section 9 of the Health Protection and Promotion Act.
8) Any amalgamation of existing public health units must be predicated on evidence-based conclusions that it will demonstrably improve the capacity to deliver public health programs and services to the residents of that area. Any changes to boundaries must respect and preserve existing municipal and community stakeholder relationships.
9) Provincial supports (financial, legal, administrative) must be provided to assist existing local public health agencies in their transition to any new state without interruption to front-line services.
alPHa Statement of Principles - Public Health Modernization November 2019 Page 2 924
Governance Principles
10) The local public health governance body must be autonomous, have a specialized and devoted focus on public health, with sole oversight of dedicated and non-transferable public health resources.
11) The local public health governance body must reflect the communities that it serves through local representation, including municipal, citizen and / or provincial appointments from within the area. Appointments should be made with full consideration of skill sets, reflection of the area’s socio- demographic characteristics and understanding of the purpose of public health.
12) The leadership role of the local Medical Officer of Health as currently defined in the Health Protection and Promotion act must be preserved with no degradation of independence, leadership or authority.
DESIRED OUTCOMES
• Population health in Ontario will benefit from a highly skilled, trusted and properly resourced public health sector at both the provincial and local levels. • Increased public and political recognition of the critical importance of investments in health protection and promotion and disease prevention to population health and the sustainability of the health care system. • Local public health will have the capacity to efficiently and equitably deliver both universal public health programs and services and those targeted at at-risk / vulnerable / priority populations. • The geographical and organizational characteristics of any new local public health agencies will ensure critical mass to efficiently and equitably deliver public health programs and services in all parts of the province. • The geographical and organizational characteristics of any new local public health agencies will preserve and improve relationships with municipal governments, boards of education, social services organizations, First Nations communities, Ontario Health Teams and other local stakeholders. • The geographical and organizational characteristics of any new local public health agencies will reflect the geographical, demographic and social makeup of the communities they serve in order to ensure that local public health needs are assessed and equitably and efficiently addressed. • Local public health will benefit from strong provincial supports, including a robust Ontario Agency for Health Protection and Promotion (Public Health Ontario) and a robust and independent Office of the Chief Medical Officer of Health. • The expertise and skills of Ontario’s public health sector will be recognized and utilized by decision makers across sectors to ensure that health and health equity are assessed and addressed in all public policy.
alPHa Statement of Principles - Public Health Modernization November 2019 Page 3 925 alPHa Association of Local PUBLIC HEALTH Agencies Association of Local Public Health Agencies Speaking Points Standing Committee on Finance and Economic Affairs Re: 2020 Ontario Budget Friday, January 17, 2020
• Good afternoon, Chair and Members of the Standing Committee on Finance and Economic Affairs.
• I am Dr. Eileen de Villa, Vice-President of the Association of Local Public Health Agencies, better known as alPHa, and Toronto’s Medical Officer of Health and with me is Loretta Ryan, alPHa’s Executive Director.
• alPHa represents all of Ontario’s 34 boards of health and medical officers of health (MOHs).
• As you may know, in essence, the work of public health is organized in the Ontario Public Health Standards as follows:
o Chronic Disease Prevention and Well-Being o Emergency Management o Food Safety o Health Equity o Healthy Environments o Healthy Growth and Development o Immunization o Infectious and Communicable Diseases Prevention and Control o Population Health Assessment
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o Safe Water o School Health o Substance Use and Injury Prevention
• Last January, in the alPHa Pre-Budget Submission, alPHa noted that:
o Public Health is on the Front Line of Keeping People Well o Public Health Delivers an Excellent Return on Investment o Public Health is an Ounce of Prevention that is Worth a Pound of Cure o Public Health Contributes to Strong and Healthy Communities o Public Health is Money Well Spent
• Furthermore, alPHa recommended that:
o The integrity of Ontario’s public health system be maintained o The Province continue its funding commitment to cost-shared programs o The Province make other strategic investments, including in the public health system, that address the government’s priorities of improving services and ending hallway medicine
• As regards to this last point, Public Health’s contribution to ending hallway medicine is summarized in alPHa’s Public Health Resource Paper .
• Despite this advice, the 2019 Ontario Budget announced that the Government would be changing the way the public health system was organized and funded.
• On October 10, 2019, Ontario named Jim Pine as its Advisor on Public Health (and Emergency Health Services) consultations.
• Subsequently, on November 18, the Ministry of Health launched renewed Public Health consultations and released a Discussion Paper.
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• alPHa was pleased with these recent announcements and has been fully engaged with the consultation.
• For example, on November 15, alPHa released a Statement of Principles respecting Public Health Modernization.
• On a funding note, as was reported by alPHa on September 11, the Ministry of Health confirmed the cost-sharing formula for public health will change to 70% provincial/30% municipal to be applied to almost all mandatory public health programs and services.
• That said, as the Premier announced on August 19 at the AMO Conference, and which alPHa welcomed, municipalities would be receiving one-time transitional funding to limit the increase in costs borne by municipalities in 2020 to no more than 10%.
• Despite this, many boards of health have reported that they have had to draw on their reserves to ease the financial burden that this decision has placed on their obligated municipalities .
• A more positive announcement in the 2019 Ontario budget was the decision to proceed with a new 100% provincially funded, public health unit delivered Ontario Seniors Dental Care Program (OSDCP), which was officially launched on November 20.
• alPHa believes that a modernized, effective and efficient public health system that is adequately resourced is needed more than ever.
• alPHa agrees, for example, with the Standing Committee on Public Accounts Report about the importance of addressing key chronic disease risk factors such as physical inactivity, unhealthy eating, alcohol consumption and
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tobacco use of which the attributable burden of illness places huge demands on the health care system.
• Moreover, in its presentation to the Standing Committee on Social Policy, alPHa warned about the unforeseen consequences of the legalization of cannabis and the promotion of vapour products, such as e-cigarettes and other similar products.
• Finally, as the Office of the Chief Medical Officer of Health has recently noted, the Public Health Agency of Canada is tracking a novel coronavirus outbreak in Wuhan, China; as our experience with SARS demonstrated, infectious diseases “know no borders”.
• With all the foregoing in mind, alPHa respectfully recommends the following:
o Led by Ontario’s Advisor, the Ministry of Health continue to pursue meaningful consultations with key stakeholders, including alPHa, respecting Public Health Modernization o Any changes to the public health system be implemented in accordance with alPHa’s Statement of Principles and pending response to the Public Health Modernization discussion paper o The public health system receives sufficient and sustainable funding to address population health needs o Ontario preferably restore the previous provincial-municipal cost- sharing (75/25) formula for Public Health and, at the very least, make no further changes to the current (70/30) formula o Ontario continue to invest in Public Health operations and capital, including 100% funding for priority programs, such as OSDCP
• Thank you for your attention. We would be pleased to answer any questions.
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STANDING COMMITTEE ON FINANCE AND ECONOMIC AFFAIRS FRIDAY 17 JANUARY 2020 PRE-BUDGET CONSULTATIONS
Full Transcript (all presentations)
Association of Local Public Health Agencies
The Chair (Mr. Amarjot Sandhu): Next, I would like to call upon the Association of Local Public Health Agencies. Please state your name for the record. You have seven minutes for your presentation.
Dr. Eileen de Villa: Thank you very much. Good afternoon, Chair and members of the Standing Committee on Finance and Economic Affairs. I’m Dr. Eileen de Villa, vice- president of the Association of Local Public Health Agencies, better known as ALPHA, and I’m also Toronto’s medical officer of health. I’m joined today by my colleague Loretta Ryan, ALPHA’s executive director.
ALPHA represents all of Ontario’s 34 boards of health and medical officers of health. As you may know, in essence, the work of public health is organized in the Ontario Public Health Standards as follows: chronic disease prevention and well-being, emergency management, food safety, health equity, healthy environments, healthy growth and development, immunization, infectious and communicable diseases prevention and control, population health assessment, safe water, school health, substance use, and injury prevention.
Last January, in the ALPHA pre-budget submission, ALPHA noted that public health is on the front line of keeping people well. Public health delivers an excellent return on investment. Public health is an ounce of prevention that is worth a pound of cure. Public 930
health contributes to strong and healthy communities, and public health is money well spent.
Furthermore, ALPHA recommended that the integrity of Ontario’s public health system be maintained, that the province continue its funding commitment to cost-shared programs and that the province make other strategic investments, including in the public health system, that address the government’s priorities of improving services and ending hallway health care. In regard to this last point, public health’s contribution to ending hallway health care is summarized in ALPHA’s public health resource paper.
Despite this advice, the 2019 Ontario budget announced that the government would be changing the way the public health system was organized and funded.
On October 10, 2019, Ontario named Jim Pine as its adviser on public health and on emergency health services for the consultations. Subsequently, on November 18, the Ministry of Health launched renewed public health consultations and released a discussion paper. ALPHA was pleased with these recent announcements and has been fully engaged with the consultation. For example, on November 15, ALPHA released a statement of principles respecting public health modernization.
On a funding note, on September 11, the Ministry of Health confirmed that the cost- sharing formula for public health will change to 70% provincial and 30% municipal, to be applied to almost all mandatory public health programs and services. This said, as the Premier announced on August 19 at the AMO conference—and which ALPHA welcomed—municipalities would be receiving one-time transitional funding to limit the increase in costs borne by municipalities in 2020 to no more than 10%. Despite this, many boards of health have reported that they have had to draw on their reserves to ease the financial burden that this decision has placed on their obligated municipalities. 931
A more positive announcement in the 2019 Ontario budget was the decision to proceed with a new, 100% provincially funded, public-health-unit-delivered Ontario Seniors Dental Care Program, or OSDCP, which was officially launched on November 20.
ALPHA believes that a modernized, effective and efficient public health system that is adequately resourced is needed more than ever. ALPHA agrees, for example, with the Standing Committee on Public Accounts report about the importance of addressing key chronic disease risk factors, such as physical inactivity, unhealthy eating, alcohol consumption and tobacco use, of which the attributable burden of illness places huge demands on the health care system. Moreover, in its presentation to the Standing Committee on Social Policy, ALPHA warned about the unforeseen consequences of the legalization of cannabis and the promotion of vapour products, such as e-cigarettes and other similar products.
Finally, as the Office of the Chief Medical Officer of Health has recently noted, the Public Health Agency of Canada is tracking a novel coronavirus outbreak in Wuhan, China. As our experience with SARS demonstrated, infectious diseases know no borders.
With all the foregoing in mind, ALPHA respectfully recommends the following:
—led by Ontario’s adviser, the Ministry of Health continue to pursue meaningful consultations with key stakeholders, including ALPHA, respecting public health modernization;
—any changes to the public health system be implemented in accordance with ALPHA’s statement of principles and pending response to the public health modernization discussion paper; 932
—that the public health system receive sufficient and sustainable funding to address population health needs—
The Chair (Mr. Amarjot Sandhu): One minute.
Dr. Eileen de Villa:—that Ontario preferably restore the previous provincial-municipal cost sharing 75-25 formula for public health and, at the very least, make no further changes to the current 70-30 formula; and
—that Ontario continue to invest in public health operations and capital, including 100% funding for priority programs such as the Ontario Seniors Dental Care Program.
I’ll thank you for your attention, and we would be very pleased to address any questions you might have.
The Chair (Mr. Amarjot Sandhu): Thank you. We’ll go to the opposition side this time. MPP Shaw.
Ms. Sandy Shaw: Thank you very much for your presentation. I commend you for your work. I would say that people didn’t understand what public health did previous to these abrupt changes; we understand it now.
I would also like to say, we remember when SARS happened, and Dr. Sheela Basrur— the heroic efforts that we took to prevent that from being a full-blown crisis. It was 15 or 16 years ago; how quickly we forget, right? So I think we need to keep reminding ourselves that when we need public health to be able to mobilize, we really, really need it. 933
So I want to commend you. I understand the work that you do. I always did. I want to say that we’re fully supportive of what you do. There’s no misunderstanding on the part of the New Democrats of what you do.
My question is very specific because we’ve got a short time. About the changes to the public health unit, the geographic deployment—so 35 units that are going to now, perhaps, be shrunk down to 10. This is a question about my riding in Hamilton, where our medical officer of health, Dr. Richardson, has expressed some of her concerns, particularly now that we are an Ontario health team and we do not know how the Ontario health team is trying to get on with their work without any direction—really clear direction, I would say—from the government and without the understanding that this public health unit will now maybe be beyond the geographic area of the Ontario health team.
So there’s a lot of confusion out there in terms of what’s happening. I’m wondering if you have any understanding of that or any advice around what the impact will be when these health units shrink.
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Dr. Eileen de Villa: Thank you for the question. At this stage of the game and as alluded to in my remarks, there are ongoing consultations right now in respect of public health modernization as proposed by the current provincial government. My understanding at this stage is that there is still open discussion with respect to what will be the configuration of local public health units. You’re right: Right now, there are currently 34. There were some original proposals made last year. We’re understanding at this stage of the game that there is some revisiting, a “reset,” I believe, is the word that has been used. So we don’t know yet where the discussions will land. 934
However, I would say that there are some important questions to ask here and some important considerations for the committee. First public health as a system is separate from the health care system. There are important areas of interaction that we need to have between public health and health care, but they are in fact distinct and separate. The Ontario health teams fall more within the context of health care, and that’s a very important role that needs to be played. I think there are certainly some questions as to how that will manifest itself in the future. However, it is in fact separate from public health.
The Chair (Mr. Amarjot Sandhu): One minute.
Dr. Eileen de Villa: That’s not to take away from its importance.
Ms. Sandy Shaw: Thank you.
The Chair (Mr. Amarjot Sandhu): MPP Arthur.
Mr. Ian Arthur: Thank you so much for your presentation. I echo the sentiments of my colleague.
Just very quickly: The upstream causes of health care costs were talked about for a long time. It seems to have receded a bit in terms of the discussion. With skyrocketing health care costs, do you see any avenue other than dealing with those upstream causes for bringing those expenditures under control?
Dr. Eileen de Villa: Thank you for the question. As a public health practitioner, we are all about the upstream. That is our focus. That is where we live, and that’s where we provide the most value to the system. There will always be some need for health care, which is downstream. However, we know that what constitutes and what maintains 935
health are the social determinants of health, the conditions within which people live and the environments within which they live—
The Chair (Mr. Amarjot Sandhu): Thank you. I apologize to cut you off. We’ll have to move to the government side now. MPP Skelly.
Ms. Donna Skelly: Thank you for your presentation. This year our government committed over $700 million—close to $800 million—in funding for public health units right across Ontario. Yes, we believe that there is an opportunity and several challenges moving forward in the restructuring and modernization of delivery of those services, and we are consulting, I believe under the leadership and direction of Jim Pine. He is the emergency health services adviser. He is leading the dialogue, meeting with representatives from municipalities, meeting with health service sector representatives from right across the province, in order to understand what the challenges are, in order to identify perhaps some of the duplication of services. We have seen examples that have been brought forward to our government.
I’m just wondering if maybe you could, while we have this opportunity at this committee hearing, share with this committee some of the areas that you have identified as duplication in the delivery of health care services under these current boards.
Dr. Eileen de Villa: Thank you for the question. I’m going to talk about duplication in respect of public health as opposed to health care.
Ms. Donna Skelly: I should say “public health.” Thank you.
Dr. Eileen de Villa: Yes, because they are quite distinct, as I indicated earlier. You’re quite right around the consultations; I think that there is an opportunity to engage in conversation around what’s best for public health. The public health system, however, does require the co-operation and collaboration of several partners. There’s certainly a 936
role for provincial entities. There’s a role for local entities, some of which are governmental and some of which are community-based.
Where are there areas that we could improve? There are always areas for improvement, whether we’re talking about public health or health care. When it comes to public health, I think what we have seen through the various reports—some of which emanated from local public health; some of which have come through Auditor General- type reports—would include areas like research.
I think there is an opportunity, as well, to confer across the province around what are some of the directions and priorities that we should be seeking together, because we know that where we have had success in public health in the past, most of the successes have come through the collaborative efforts of a variety of local or regional public health entities, as well as the province.
I think those are just a few examples of some areas where we could collaborate better and perhaps reduce duplication.
Ms. Donna Skelly: One of the programs that you raised involves dental care for seniors, which is, of course, something I think most of us really believe is long overdue.
The Chair (Mr. Amarjot Sandhu): One minute.
Ms. Donna Skelly: Can you speak to some of the limitations, some of your observations, since we’ve started introducing that program?
Dr. Eileen de Villa: It’s a relatively new program, launched in November and currently being delivered through public health units. I would say that for many of my colleagues around the province, one of the challenges is that they did not have pre-existing seniors’ 937
dental care programs, or facilities through which to deliver such clinical services. Certainly, establishing those facilities is one of the challenges that exist right now.
But as mentioned in our remarks, we at ALPHA are extremely pleased. This was certainly one of the positives in respect of recent funding announcements when it came to public health and public health delivery programs.
Ms. Donna Skelly: Thank you.
The Chair (Mr. Amarjot Sandhu): Thank you so much for your presentation. 938
480 University Avenue, Suite 300 Toronto ON M5G 1V2 alPHa Tel: (416) 595-0006 E-mail: [email protected] Association of Local PUBLIC HEALTH Agencies Providing leadership in public health management
N O T I C E 2020 ANNUAL GENERAL MEETING
NOTICE is hereby given that the 2020 Annual General Meeting of the ASSOCIATION OF LOCAL PUBLIC HEALTH AGENCIES will be held at the Chestnut Conference Centre, 89 Chestnut Street, Toronto, Ontario on Monday, June 8, 2020 at 8:00 AM at the 2020 Annual Conference, for the following purposes:
1. To consider and approve the minutes of the 2019 Annual General Meeting in Kingston, Ontario;
2. To receive and adopt the annual reports from the President, Executive Director, Section Chairs and others as appropriate;
3. To consider and approve the Audited Financial Statement for 2019-2020;
4. To appoint an auditor for 2020-2021; and
5. To transact such other business as may properly be brought before the meeting.
DATED at Toronto, Ontario, January 20, 2020.
BY THE ORDER OF THE BOARD OF DIRECTORS.
Loretta Ryan Executive Director 940
alPHa Association of Local PUBLIC HEALTH Agencies
Call for Resolutions alPHa members are invited to submit resolutions for consideration at the 2020 alPHa Annual General Meeting & Resolutions Session during the Annual Conference in June.
It is important that resolutions are drafted using the "Procedural Guidelines for alPHa Resolutions" found by clicking here.
We request that resolutions be limited to one operative clause per issue (other than specific directions on whom to advise) to allow for focused advocacy and monitoring.
Who may submit? • a member board of health • a Section Executive Committee, or general meeting of a Section • the alPHa Board of Directors, its Executive Committee or a Standing Committee of the Association; or • an Affiliate member organization
What is required? • resolutions must first be endorsed by a properly constituted body, i.e. a board of health, a Section of alPHa, etc. • a covering letter specifying your submission must accompany the resolution(s) • proper formatting according to procedural guidelines, including clearly-worded introductory and operative clauses • any concise background material to help prepare members voting on the issue
When is the deadline to submit? • Friday, April 23, 2020, 4:30 PM for all resolutions that do not request a change in alPHa’s Constitution. • For resolutions to amend the alPHa Constitution, the deadline is April 8, 2020, 4:30 PM. • Taking into account that a late resolution may be necessary in response to a current event, you may bring a late resolution to the Resolutions Session. These late resolutions, however, will not have the benefit of being reviewed by alPHa's Executive Committee and there will be a vote during the Resolutions Session to determine if the membership will consider late resolutions. If the vote is successful, your resolution will be brought forward and considered.
When will resolutions be debated by the alPHa membership? • There will be a special session to consider resolutions immediately following the Annual General Meeting portion of the Annual Conference.
How may I submit the resolutions? • only electronic submissions in MS Word will be accepted; click here to download a template. • e-mail to: Susan Lee, Manager, Administrative & Association Services, alPHa [email protected] 941
alPHa Association of Local PUBLIC HEALTH Agencies C A L L F O R N O M I N A T I O N S alPHa Distinguished Service Award
The Distinguished Service Award (DSA) is awarded annually by the Association of Local Public Health Agencies to individuals in recognition of their outstanding contributions made to public health in Ontario.
How many awards are given yearly? • One award per Section and Affiliate organization may be presented in any given year. • On occasion, an award may be given to individuals outside alPHa for their contributions to public health.
Who is eligible to receive the DSA? • Members of alPHa who fall under the following categories are eligible: o an elected/appointed member of a local board of health or regional health committee; o a medical officer of health or associate medical officer of health; o one of alPHa's seven affiliated organizations (i.e. AOPHBA, APHEO, ASPHIO, HPO, OAPHD, ODPH, OPHNL). • An individual outside the alPHa membership who has made outstanding contributions to public health in Ontario.
Who deserves the DSA? • Eligible recipients have: o demonstrated exceptional qualities of leadership in his/her own milieu; o achieved tangible results through lengthy service and/or distinctive acts; and o displayed exemplary devotion to public health at the provincial level.
What are the eligibility criteria for nominees? • Nominees: o currently hold a position of significant responsibility in one of alPHa's member agencies (i.e. board of health/local public health unit/affiliated organization) and have been a member in alPHa for at least three years; and o have been nominated by at least three voting members from the nominee's Section or Affiliate organization who are in good standing of alPHa.
Note: 1. good standing refers to members who have paid their membership dues; 2. voting members are individuals representing a member health unit. These individuals include board of health chairs, medical and associate medical officers of health, and representatives appointed to the alPHa Board of Directors by the seven alPHa Affiliate organizations.
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alPHa DSA Call for Nominations cont’d
Who can nominate? • Any member of alPHa including Board of Health members, medical and associate medical officers of health, and Affiliate representatives may nominate. Please note that three (3) Section or Affiliate members of alPHa must sign the nomination form. • In the case of nominations of non-members of alPHa, nominations must come from any three (3) active members of alPHa; only alPHa members may nominate potential candidates. • The Award is presented on behalf of each of alPHa’s various membership groups, i.e. the Boards of Health Section, Council of Ontario Medical Officers of Health (COMOH), and the seven Affiliate organizations of alPHa. Therefore, nominations must be issued by the nominee’s Section or Affiliate organization (i.e. nominations of Board of Health members must come from the Board of Health Section; nominations of medical/associate medical officers of health must come from the Council of Ontario Medical Officers of Health; and nominations of senior public health staff must come from the nominee’s respective Affiliate organization). If you want to recommend an individual for nomination by their Section or Affiliate organization, please contact the Chair or President of the respective Section or Affiliate organization.
What materials must accompany the nomination form? 1. Signatures of the nominator and two (2) other supporting voting members of alPHa. 2. A cover letter explaining why the nominee is deserving of this award. Since the members of the Selection Committee more than likely will not know the nominee, they will base their assessment on what is conveyed to them in the cover letter. The letter should tell the Selection Committee what the nominee has achieved and why it is outstanding. 3. A service record or curriculum vitae that includes the following: • personal achievements at the local level; • special or distinctive services on behalf of public health provincially; • leadership and contributions on behalf of alPHa and/or one of its Sections; an affiliated organization; or a provincial public health organization.
Where should I send the nominations to? • Nomination forms along with all relevant accompaniments should be e-mailed to Susan Lee, Manager, Administrative and Association Services, alPHa, at [email protected]
When is the deadline to submit nominations? • Tuesday, April 14, 2020, 4:30 PM
Who selects the DSA recipients? • All nominations are reviewed by the Executive Committee of alPHa. • In the event of a tie, the alPHa Board of Directors will determine the Award recipient.
How are Award recipients notified? • Award recipients are notified in writing by alPHa approximately one month prior to the conference date. • Award recipients are invited to attend as guests of the association at the Annual Awards Luncheon, which is held during the Annual Conference.
Who can I contact if I have further questions on the Awards? • Susan Lee, Manager, Administrative and Association Services, alPHa • tel: (416) 595-0006 ext. 225, e-mail: [email protected] 2 943 alPHa 2020 NOMINATION FORM Association of Local Distinguished Service Award PUBLIC HEALTH Agencies
I HEREBY NOMINATE THE FOLLOWING INDIVIDUAL TO RECEIVE THE alPHa DISTINGUISHED SERVICE AWARD:
Nominee: ______Title: ______Health Unit/Agency/Org’n: ______Mailing Address: ______Email: ______Telephone: ______Membership Group within alPHa (choose one): BOH COMOH AOPHBA APHEO ASPHIO HPO OAPHD ODPH OPHNL OTHER
NOMINATOR’S SIGNATURE:
Name (please print): ______Title: ______Health Unit/Agency/Org’n: ______Email: ______Signature: ______Date: ______
SUPPORTING SIGNATURES (must be different from nominator):
1.______Name (please print): ______
2.______Name (please print): ______
This completed form must be accompanied by a cover letter and service record or curriculum vitae to at least include a list of personal achievements at the local level, special or distinctive services on behalf of public health provincially and contributions on behalf of alPHa and/or one of its Sections, affiliated organizations or a provincial health organization.
Please forward by April 14, 2020, 4:30 PM to: Susan Lee, Manager, Admin. & Assoc. Services Association of Local Public Health Agencies E-mail: [email protected] 944
alPHa Association of Local PUBLIC HEALTM Agencies
CALL FOR BOARD OF HEALTH NOMINATIONS 2020-2021 & 2021-2022 alPHa BOARD OF DIRECTORS
alPHa is accepting nominations for three Board of Health representatives from the following regions for the following term on its Board of Directors:
1. Central East 2. North East 2-year term each 3. North West } (i.e. June 2020 to June 2021 & June 2021 to June 2022)
See the attached appendix for boards of health in each of these regions.
Each position will fill a seat on the Boards of Health Section Executive Committee and a seat on the alPHa Board of Directors.
Qualifications: • Active member of an Ontario Board of Health (or regional health committee) that is a member organization of alPHa; • Background in committee and/or volunteer work; • Supportive of public health; • Able to commit time to the work of the alPHa Board of Directors and its committees; • Familiar with the Ontario Public Health Standards.
An election to determine the representatives will be held at the Boards of Health Section Meeting on June 9 during the 2020 alPHa Annual Conference, Chestnut Conference Centre, 89 Chestnut Street, Toronto, Ontario.
Nominations close 4:30 PM, Friday, May 29, 2020.
Why stand for election to the alPHa Board? • Help make alPHa a stronger leadership organization for public health units in Ontario; • Represent your colleagues at the provincial level; • Bring a voice to discussions reflecting common concerns of boards of health and health unit management across the province; • Expand your contacts and strengthen relationships with public health colleagues;
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• Lend your expertise to the development of alPHa position papers and official response to issues affecting all public health units; and • Learn about opportunities to serve on provincial ad hoc or advisory committees.
What is the Boards of Health Section Executive Committee of alPHa? • This is a committee of the alPHa Board of Directors comprising seven (7) Board of Health representatives. • It includes a Chair and Vice-Chair who are chosen by the Section Executive members. • Members of the Section Executive attend all alPHa Board meetings and participate in teleconferences throughout the year.
How long is the term on the Boards of Health Section Executive/alPHa Board of Directors? • A full term is two (2) years with no limit to the number of consecutive terms. • Mid-term appointments will be for less than two years.
How is the alPHa Board structured? • There are 22 directors on the alPHa Board: o 7 from the Boards of Health Section o 7 from the Council of Ontario Medical Officers of Health (COMOH) o 1 from each of the 7 Affiliate Organizations of alPHa, and o 1 from the Ontario Public Health Association Board of Directors. • There are 3 committees of the alPHa Board: Executive Committee, Boards of Health Section Executive, and COMOH Executive.
What is the time commitment for a Section Executive member/Director of alPHa? • Half-day alPHa Board meetings are held in person 4 times a year in Toronto; a fifth and final meeting is held at the June Annual Conference. • Boards of Health Section Executive Committee teleconferences are held 5 times throughout the year. • The Chair of the Boards of Health Section Executive participates on alPHa Executive Committee teleconferences, which are held 5 times a year.
Are my expenses as a Director of the alPHa Board covered? • Any expenses incurred by an alPHa Director during Association meetings are not covered by the Association but are the responsibility of the Director's sponsoring health unit.
How do I stand for consideration for appointment to the alPHa Board of Directors? • Submit a completed Form of Nomination and Consent along with a biography of your suitability for candidacy and a copy of the motion from your Board of Health supporting your nomination to alPHa by May 29, 2020.
Who should I contact if I have questions on any of the above? • Susan Lee, alPHa, Tel: (416) 595-0006 ext. 225, E-mail: [email protected] 946
Appendix to Nomination and Consent Form – alPHa Board of Directors 2020-2021 & 2021-2022
Board of Health Vacancies on alPHa Board of Directors
alPHa is accepting nominations for three Board of Health representatives to fill positions on its 2020- 2021 and 2021-2022 Board of Directors from the following regions and for the following terms:
1. Central East 2. North East 2-year term each 3. North West } (i.e. June 2020 to June 2021 & June 2021 to June 2022)
See below for boards of health in these regions.
Each position will fill a seat on the Boards of Health Section Executive Committee and a seat on the alPHa Board of Directors. An election will be held at alPHa’s annual conference in June to determine the new representatives (one from each of the regions below). If you are an active member of a Board of Health/Regional Health Committee who is interested in running for a seat, please consider standing for nomination.
Central East Region Boards of health in this region include:
Durham HKPR Peel Peterborough Simcoe Muskoka York Region
North East Region Boards of health in this region include:
Algoma North Bay Parry Sound Porcupine Sudbury Timiskaming
North West Region Boards of health in this region include:
Northwestern Thunder Bay 947 alPHa Association of Local FORM OF NOMINATION AND CONSENT PUBLIC HEALTH Agencies alPHa Board of Directors 2020-2021 & 2021-2022
______, a Member of the Board of Health of (Please print nominee’s name)
______, is HEREBY NOMINATED (Please print health unit name) as a candidate for election to the alPHa Board of Directors for the following Boards of Health Section Executive seat from (choose one using the list of Board of Health Vacancies on previous pages)
Central East Region (2 year term)
North East Region (2 year term)
North West Region (2 year term)
AND SPONSORED BY THE FOLLOWING MEMBERS OF THE BOARD OF HEALTH:
1) Name: ______Signature: ______
2) Name: ______Signature: ______
I, ______, HEREBY CONSENT to my nomination and agree to serve (Please print name of nominee) as a DIRECTOR OF THE alPHa BOARD if appointed.
Nominee’s Signature: ______Date: ______
IMPORTANT:
1. Nominations close 4:30 PM, May 29, 2020 and must be submitted to alPHa by this deadline.
2. A biography of the nominee outlining their suitability for candidacy, as well as a motion passed by the sponsoring Board of Health (i.e. record of a motion from the Clerk/Secretary of the Board of Health) must also be submitted along with this nomination form on separate pages by the deadline.
3. E-mail the completed form, biography and copy of Board motion by 4:30 PM, May 29, 2020 to Susan Lee at [email protected] 948 949 a 519-258-2146 I www.wechu.org ----Windsor 1005 Ouellette Avenue, Windsor, ON N9A 4J8 ~LiH"U'riit Essex 360 Fairview Avenue West, Suite 215, Essex, ON N8M 3G4 Bureau de sante de Windsor-comte d'Essex 11 Leamington 33 Princess Street, Leamington, ON N8H 5C5
January 17, 2020
The Honorable Christine Elliott Minister of Health and Deputy Premier Hepburn Block 10th Floor 80 Grosvenor Street Toronto, ON M7A 1E9
Dear Minister Elliott:
On December 18, 2019, the Windsor-Essex County Board of Health passed the following Resolution regarding Healthy Smiles Ontario Funding. WECHU’s resolution as outlined below recognizes the growing need, and increase in dental decay, among vulnerable children in Windsor-Essex and existing barriers to access to care. The WECHU recommends that HSO retain its current funding and structure as 100% funded, merging it with the Ontario Seniors Dental Care Program to be a comprehensive dental care program for vulnerable children and seniors in Ontario:
Windsor-Essex County Board of Health RECOMMENDATION/RESOLUTION REPORT – Healthy Smiles Ontario Funding December 19, 2019
ISSUE Healthy Smiles Ontario (HSO) is a publically funded dental care program for children and youth 17 years old and under from low-income households. The Ministry of Health introduced HSO in 2010 as a 100% provincially funded mandatory program for local health units, providing $1,529,700 in funding for children in Windsor-Essex (2019). HSO covers regular visits to a licensed dental provider within the community or through public health units.
In April 2019, the provincial government introduced its 2019 Budget Protecting What Matters Most (Minister of Finance, 2019). Following the release of the provincial budget, the Ministry of Health introduced changes to the funding models for health units effective January 2020. The changes in funding for local health units include a change from a 25% municipal share, 75% provincial cost- shared budget for mandatory programs to 30% and 70% respectively. In addition, the Ministry notified health units that formerly 100% provincially funded mandatory programs such as HSO would now share these costs with municipalities at the rate of 30%, a download of approximately $458,910.00 to local municipalities.
BACKGROUND Oral health is vital to our general health and overall well-being at every stage of life. Most oral health conditions are largely preventable and share common risk factors with other chronic diseases, as well as the social determinants of health, such as income, employment and education, whereby those in the lowest income categories have the poorest oral health outcomes. Approximately 26% of children (0-5 yrs) and 22.6% of children and youth (0-17yrs) in Windsor- 950
Essex County live in low-income households, compared to 19.8% and 18.4% in Ontario (Windsor- Essex County Health Unit, 2019). Tooth decay is one of the most prevalent and preventable chronic disease, particularly among children. In Windsor-Essex from 2011 to 2016, the number of children screened in school with decay and/or urgent dental needs increased by 51%. Tooth decay is also the leading cause of day surgeries for children ages one to five. The rate of day surgeries in Windsor-Essex in 2016 was 300.6/100K compared to 104.0/100K for Ontario, representing a significant cost and burden to the healthcare system (WECHU Oral Health Report, 2018). For children, untreated oral health issues can lead to trouble eating and sleeping, affect healthy growth and development, speech and contribute to school absenteeism.
In 2016, the MOHLTC integrated six publicly funding dental programs into one 100% funded program, providing a simplified enrolment process and making it easier for eligible children to get the care they need. The HSO program was part of Ontario’s Poverty Reduction Strategy commitment to build community capacity to deliver oral health prevention and treatment services to children and youth from low-income families in Ontario. Windsor-Essex Health Unit operates two dental clinics, one in Windsor and one clinic in Leamington. The WECHU provides preventative and restorative services with a team of registered dental hygienists, general dentists and a pediatric dentist. There is about a six-month wait list for services in our current clinics. The number of preventative oral health services provided through the WECHU dental clinics has increased year over year from 1,931 in 2011 to 7,973 in 2017 (WECHU Oral Health Report, 2018).
Community dentists are not required to take patients under the Healthy Smiles Ontario program which can create barriers to accessing services. Changes to the funding model for HSO will not affect the services provided by local dentists and is only applied to local health units. Mixed model funding for public health units and private fee-for-service dental providers, poses a risk to the delivery of the HSO program in Ontario. Based on the data and analysis in the 2018 Oral Health report, the Windsor-Essex County Health Unit proposed recommendations to improve the oral health status in Windsor-Essex including: Improve access to oral health services within Windsor- Essex and advocate for improved funding for oral health services and expansion of public dental programs such as Healthy Smiles Ontario to priority populations. Given the growing urgent need and increase in dental decay among vulnerable children in Windsor-Essex and recognizing the existing barriers to access to care, the WECHU recommends that HSO retain its current funding and structure as 100% funded, merging it with the Ontario Seniors Dental Care Program to be a comprehensive dental care program for vulnerable children and seniors in Ontario.
PROPOSED MOTION Whereas the WECHU operates a dental clinic in Leamington and Windsor for HSO eligible children with wait times for services exceeding 6 months, and
Whereas one in four children under five years (26.0%), one in five children under 17 years (22.6%), and one in ten seniors (11.4%) in Windsor and Essex County live in poverty, and
Whereas inadequate access and cost remain barriers to dental care for Windsor and Essex County residents, 23.7% report that they lack dental insurance that covered all or part of the cost of seeing a dental professional, and
Whereas indicators show an overall trend of declining oral health status among children in Windsor and Essex County compared to Ontario, and 951
Whereas the rate of oral health day surgeries for children in Windsor and Essex County (300.6/100K) far exceeds that of Ontario (100.4/100K), and
Whereas there is an increased difficulty in obtaining operating room time for dental procedures in Windsor-Essex with wait times exceeding 1 year for children in need of treatment, and
Whereas there is a chronic underfunding of the Healthy Smiles Ontario program creating barriers to accessing services among local dentists, and
Now therefore be it resolved that the Windsor-Essex County Board of Health recognizes the critical importance of oral health for vulnerable children and youth, and
FURTHER THAT, urges the Ministry of Health to reconsider its decision to download 30% of the funding of the Healthy Smiles Ontario Program to local municipalities, and
FURTHER THAT this resolution be shared with the Ontario Minister of Health, the Chief Medical Officer of Health, the Association of Municipalities of Ontario, local MPP’s, the Association of Public Health Agencies, Ontario Boards of Health, the Essex County Dental Society, the Ontario Association of Public Health Dentistry, the Ontario Dental Association and local municipalities and stakeholders .
References:
Windsor-Essex County Health Unit. (2019). Community Needs Assessment 2019 Update. Windsor, Ontario Windsor-Essex County Health Unit. (2018). Oral Health Report, 2018 Update. Windsor, Ontario
We would be pleased to discuss this resolution with you and thank you for your consideration. Sincerely,
Gary McNamara Theresa Marentette Chair, Board of Health Chief Executive Officer c: Hon. Doug Ford, Premier of Ontario Hon. Patty Hadju, Minister of Health Dr. David Williams, Chief Medical Officer of Health, Ministry of Health & Long Term Care Pegeen Walsh, Executive Director, Ontario Public Health Association Association of Local Public Health Agencies – Loretta Ryan Association of Municipalities of Ontario Essex County Dental Society Ontario Association of Public Health Dentistry Ontario Dental Association Ontario Boards of Health WECHU Board of Health Corporation of the City of Windsor – Clerk’s office Corporation of the County of Essex – Clerk’s office Local MPP’s – Percy Hatfield, Lisa Gretzky, Taras Natyshak, Rick Nicholls Local MP’s – Brian Masse, Irek Kusmeirczyk, Chris Lewis, Dave Epp 952